Chapter 17 Chapter 17 Nutrition for Nutrition for Adulthood & Adulthood & the Later Years the Later Years

Chapter 17Chapter 17

Nutrition for Nutrition for

Adulthood & Adulthood &

the Later Yearsthe Later Years

Dietary Guidelines for Dietary Guidelines for Americans 2005Americans 2005

Dietary Guidelines for AmericansDietary Guidelines for Americans is is published jointly every 5 years by the published jointly every 5 years by the Department of Health and Human Department of Health and Human Services (HHS) and the Department of Services (HHS) and the Department of Agriculture (USDA). The Agriculture (USDA). The GuidelinesGuidelines provide authoritative advice for people provide authoritative advice for people two years and older about how good two years and older about how good dietary habits can promote health and dietary habits can promote health and reduce risk for major chronic diseases. reduce risk for major chronic diseases.

Key recommendations for the general Key recommendations for the general population population

ADEQUATE NUTRIENTS ADEQUATE NUTRIENTS WITHIN CALORIE NEEDS WITHIN CALORIE NEEDS

Consume a variety of nutrient-dense foods Consume a variety of nutrient-dense foods and beverages within and among the basic and beverages within and among the basic food groups while choosing foods that limit food groups while choosing foods that limit the intake of saturated andthe intake of saturated and trans trans fats, fats, cholesterol, added sugars, salt, and alcohol. cholesterol, added sugars, salt, and alcohol.

Meet recommended intakes within energy Meet recommended intakes within energy needs by adopting a balanced eating pattern, needs by adopting a balanced eating pattern, such as the U.S. Department of Agriculture such as the U.S. Department of Agriculture (USDA) Food Guide or the Dietary Approaches (USDA) Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.to Stop Hypertension (DASH) Eating Plan.

WEIGHT MANAGEMENTWEIGHT MANAGEMENT

To maintain body weight in a healthy To maintain body weight in a healthy range, balance calories from foods range, balance calories from foods and beverages with calories and beverages with calories expended. expended.

To prevent gradual weight gain over To prevent gradual weight gain over time, make small decreases in food time, make small decreases in food and beverage calories and increase and beverage calories and increase physical activity.physical activity.

PHYSICAL ACTIVITY PHYSICAL ACTIVITY Engage in regular physical activity and Engage in regular physical activity and

reduce sedentary activities to promote reduce sedentary activities to promote health, psychological well-being, and a health, psychological well-being, and a healthy body weight. healthy body weight. To reduce the risk of chronic disease in adulthood: To reduce the risk of chronic disease in adulthood:

Engage in at least 30 minutes of moderate-Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at intensity physical activity, above usual activity, at work or home on most days of the week. work or home on most days of the week.

For most people, greater health benefits can be For most people, greater health benefits can be obtained by engaging in physical activity of more obtained by engaging in physical activity of more vigorous intensity or longer duration. vigorous intensity or longer duration.

To help manage body weight and prevent To help manage body weight and prevent gradual, unhealthy body weight gain in gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on of moderate- to vigorous-intensity activity on most days of the week while not exceeding most days of the week while not exceeding caloric intake requirements. caloric intake requirements.

PHYSICAL ACTIVITY PHYSICAL ACTIVITY (cont.)(cont.)

To sustain weight loss in adulthood: To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity daily moderate-intensity physical activity while not exceeding caloric intake while not exceeding caloric intake requirements. Some people may need to requirements. Some people may need to consult with a healthcare provider before consult with a healthcare provider before participating in this level of activity.participating in this level of activity.

Achieve physical fitness by including Achieve physical fitness by including cardiovascular conditioning, cardiovascular conditioning, stretching exercises for flexibility, and stretching exercises for flexibility, and resistance exercises or calisthenics resistance exercises or calisthenics for muscle strength and endurance. for muscle strength and endurance.

FOOD GROUPS TO FOOD GROUPS TO ENCOURAGEENCOURAGE Consume a sufficient amount of fruits and Consume a sufficient amount of fruits and

vegetables while staying within energy vegetables while staying within energy needs. Two cups of fruit and 2½ cups of needs. Two cups of fruit and 2½ cups of vegetables per day are recommended for vegetables per day are recommended for a reference 2,000-calorie intake, with a reference 2,000-calorie intake, with higher or lower amounts depending on the higher or lower amounts depending on the calorie level. calorie level.

Choose a variety of fruits and vegetables Choose a variety of fruits and vegetables each day. In particular, select from all fiveeach day. In particular, select from all five

vegetable subgroups (dark green, orange, vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other legumes, starchy vegetables, and other vegetables) several times a week. vegetables) several times a week.

FOOD GROUPS TO FOOD GROUPS TO ENCOURAGE (cont.)ENCOURAGE (cont.)

Consume 3 or more ounce-equivalents Consume 3 or more ounce-equivalents of whole-grain products per day, with of whole-grain products per day, with the rest of the recommended grains the rest of the recommended grains coming from enriched or whole-grain coming from enriched or whole-grain products. In general, at least half the products. In general, at least half the grains should come from whole grains. grains should come from whole grains.

Consume 3 cups per day of fat-free or Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.low-fat milk or equivalent milk products.

FATSFATS Consume less than 10 percent of calories Consume less than 10 percent of calories

from saturated fatty acids and less than from saturated fatty acids and less than 300 mg/day of cholesterol, and keep 300 mg/day of cholesterol, and keep transtrans fatty acid consumption as low as possible. fatty acid consumption as low as possible.

Keep total fat intake between 20 to 35 Keep total fat intake between 20 to 35 percent of calories, with most fats coming percent of calories, with most fats coming from sources of polyunsaturated and from sources of polyunsaturated and monounsaturated fatty acids, such as fish, monounsaturated fatty acids, such as fish, nuts, and vegetable oils. nuts, and vegetable oils.

When selecting and preparing meat, When selecting and preparing meat, poultry, dry beans, and milk or milk poultry, dry beans, and milk or milk products, make choices that are lean, low-products, make choices that are lean, low-fat, or fat-free. fat, or fat-free.

Limit intake of fats and oils high in Limit intake of fats and oils high in saturated and/or saturated and/or trans trans fatty acids, and fatty acids, and choose products low in such fats and oils.choose products low in such fats and oils.

CARBOHYDRATESCARBOHYDRATES Choose fiber-rich fruits, vegetables, Choose fiber-rich fruits, vegetables,

and whole grains often. and whole grains often. Choose and prepare foods and Choose and prepare foods and

beverages with little added sugars or beverages with little added sugars or caloric sweeteners, such as amounts caloric sweeteners, such as amounts suggested by the USDA Food Guide suggested by the USDA Food Guide and the DASH Eating Plan. and the DASH Eating Plan.

Reduce the incidence of dental caries Reduce the incidence of dental caries by practicing good oral hygiene and by practicing good oral hygiene and consuming sugar- and starch-consuming sugar- and starch-containing foods and beverages less containing foods and beverages less frequently. frequently.

SODIUM AND POTASSIUMSODIUM AND POTASSIUM

Consume less than 2,300 mg Consume less than 2,300 mg (approximately 1 teaspoon of salt) of (approximately 1 teaspoon of salt) of sodium per day. sodium per day.

Choose and prepare foods with little Choose and prepare foods with little salt. At the same time, consume salt. At the same time, consume potassium-rich foods, such as fruits potassium-rich foods, such as fruits and vegetables.and vegetables.

ALCOHOLIC BEVERAGESALCOHOLIC BEVERAGES Those who choose to drink alcoholic Those who choose to drink alcoholic

beverages should do so sensibly and in beverages should do so sensibly and in moderation—defined as the consumption moderation—defined as the consumption of up to one drink per day for women and of up to one drink per day for women and up to two drinks per day for men. up to two drinks per day for men.

Alcoholic beverages should not be Alcoholic beverages should not be consumed by some individuals, including consumed by some individuals, including those who cannot restrict their alcohol those who cannot restrict their alcohol intake, women of childbearing age who intake, women of childbearing age who may become pregnant, pregnant and may become pregnant, pregnant and lactating women, children and lactating women, children and adolescents, individuals taking adolescents, individuals taking medications that can interact with alcohol, medications that can interact with alcohol, and those with specific medical conditions. and those with specific medical conditions.

Alcoholic beverages should be avoided by Alcoholic beverages should be avoided by individuals engaging in activities that individuals engaging in activities that require attention, skill, or coordination, require attention, skill, or coordination, such as driving or operating machinery such as driving or operating machinery

FOOD SAFETYFOOD SAFETY To avoid microbial foodborne illness: To avoid microbial foodborne illness:

Clean hands, food contact surfaces, and fruits Clean hands, food contact surfaces, and fruits and vegetables. Meat and poultry should not and vegetables. Meat and poultry should not be washed or rinsed. be washed or rinsed.

Separate raw, cooked, and ready-to-eat foods Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods. while shopping, preparing, or storing foods.

Cook foods to a safe temperature to kill Cook foods to a safe temperature to kill microorganisms. microorganisms.

Chill (refrigerate) perishable food promptly and Chill (refrigerate) perishable food promptly and defrost foods properly. defrost foods properly.

Avoid raw (unpasteurized) milk or any products Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, or undercooked meat and poultry, unpasteurized juices, and raw sprouts. unpasteurized juices, and raw sprouts.

Food Guide Pyramid for Disease Prevention

Copyright 2005 Wadsworth Group, a division of Thomson LearningCopyright 2005 Wadsworth Group, a division of Thomson Learning

Nutrition & Disease Nutrition & Disease PreventionPrevention

1. Appropriate energy intake help prevent 1. Appropriate energy intake help prevent

obesity, diabetes,obesity, diabetes, and related and related cardiovascular cardiovascular

diseasesdiseases and some and some cancerscancers

2. Adequate intakes of essential nutrients 2. Adequate intakes of essential nutrients

prevent prevent deficiency diseasesdeficiency diseases such as such as scurvy,scurvy,

goiter, anemiagoiter, anemia

3. Variety of food intake and ample intake 3. Variety of food intake and ample intake of of

certain vegetables may be protective certain vegetables may be protective

against certain types of against certain types of cancercancer

Nutrition & Disease Nutrition & Disease PreventionPrevention

4. Moderation in sugar intake helps prevent 4. Moderation in sugar intake helps prevent

dental cariesdental caries

5. Appropriate fiber intakes helps prevent 5. Appropriate fiber intakes helps prevent

constipation, diverticulosisconstipation, diverticulosis, and possibly , and possibly

colon cancer colon cancer

6. Moderate sodium intake and adequate6. Moderate sodium intake and adequate

intakes of potassium and calcium help intakes of potassium and calcium help

prevent prevent hypertension hypertension

7. Adequate calcium intake helps protect 7. Adequate calcium intake helps protect

against against osteoporosisosteoporosis


Aging of the U.S. Population

Goals for Older AdultsGoals for Older Adults

Quality of lifeQuality of life Promote healthPromote health Slow agingSlow aging Healthy habitsHealthy habits

Physiological agePhysiological age Chronological ageChronological age


Aging & NutritionAging & Nutrition Six lifestyle behaviors that influence Six lifestyle behaviors that influence

health & physiological age (slow the health & physiological age (slow the aging process):aging process):

1. Eat well-balanced meals, 1. Eat well-balanced meals, including including

breakfast, regularly.breakfast, regularly.

2. Maintain a healthy body weight.2. Maintain a healthy body weight.

3. Avoid alcohol, or use sparingly.3. Avoid alcohol, or use sparingly.

4. Sleep regularly & adequately.4. Sleep regularly & adequately.

Aging & NutritionAging & Nutrition5. No tobacco in any form.5. No tobacco in any form.6. Engage in physical activity 6. Engage in physical activity

regularly to maintain muscle mass regularly to maintain muscle mass & strength, improve fitness & & strength, improve fitness & mobility and reduce falls & health mobility and reduce falls & health risks (obesity, CVD, cancer,etc.)risks (obesity, CVD, cancer,etc.)

A Guide from the National Institute A Guide from the National Institute on Agingon Aging, , www.nia.nih.govwww.nia.nih.gov, , recommends endurance, strength, recommends endurance, strength, balance and flexibility exercisesbalance and flexibility exercises

http://www.nia.nih.gov/

Manipulation Of DietManipulation Of Diet

Energy restriction in animals – Energy restriction in animals – animals live longer and have fewer animals live longer and have fewer age-related diseases when energy age-related diseases when energy intake is about 70% of normalintake is about 70% of normal

Energy restriction in human beings – Energy restriction in human beings – research on extreme starvation research on extreme starvation extending life is limited; moderation extending life is limited; moderation supports good health & long lifesupports good health & long life


The Aging ProcessThe Aging Process Physiologic changes associated with Physiologic changes associated with

aging that effect nutritional status:aging that effect nutritional status:1. Change in body composition – 1. Change in body composition –

lossloss of lean body mass (sarcopenia)of lean body mass (sarcopenia)

2. Reduction in gastric acid 2. Reduction in gastric acid secretion secretion

& gastric motility& gastric motility3. Dysphagia – difficulty swallowing3. Dysphagia – difficulty swallowing4. Atropic gastritis – inflamed 4. Atropic gastritis – inflamed

stomach, bacterial overgrowth,stomach, bacterial overgrowth, lack of intrinsic factorlack of intrinsic factor

The Aging ProcessThe Aging Process

5. Altered taste & smell5. Altered taste & smell

6. Loss of vision6. Loss of vision

7. Loose of teeth and gum 7. Loose of teeth and gum diseasedisease

8. Cognitive impairment8. Cognitive impairment

9. Compromised immune 9. Compromised immune systemsystem

Aging & NutritionAging & Nutrition Risks factors for poor nutritional status:Risks factors for poor nutritional status:

1. Presence of chronic diseases effect 1. Presence of chronic diseases effect appetite, chewing & swallowing, taste, appetite, chewing & swallowing, taste, side effect of treatments, side effect of treatments,

malabsorption, malabsorption, increased nutrient needs, modified increased nutrient needs, modified

diets: diets: - Some cancers- Some cancers- Hypertension- Hypertension- Diabetes (type 2)- Diabetes (type 2)- Osteoporosis- Osteoporosis- Atherosclerosis- Atherosclerosis- Stroke- Stroke- Diverticulosis- Diverticulosis

Aging & NutritionAging & Nutrition Risk factors for poor nutritional status:Risk factors for poor nutritional status:

2. Physical disability – limitations in ADLs 2. Physical disability – limitations in ADLs

reflect capacity for self care (feeding, reflect capacity for self care (feeding,

shopping, meal preparation)shopping, meal preparation)

reflect capacity for independent livingreflect capacity for independent living

3. Cognitive impairment – memory loss, 3. Cognitive impairment – memory loss,

lose ability to concentrate, make lose ability to concentrate, make

choices, initiate activitieschoices, initiate activities

Aging & NutritionAging & Nutrition Risks factors for poor nutritional status:Risks factors for poor nutritional status:

4. Social isolation – decreased 4. Social isolation – decreased

motivation to shop & prepare meals motivation to shop & prepare meals

when living alone and cooking for one when living alone and cooking for one

5. Loneliness & depression contribute5. Loneliness & depression contribute

to loss of appetite; socialization atto loss of appetite; socialization at

meals helpful (Congregate Meals meals helpful (Congregate Meals

or Meals On Wheels) or Meals On Wheels)

Aging & NutritionAging & Nutrition Risks factors for poor nutritional statusRisks factors for poor nutritional status

6. Poverty – high rate of poverty; may be 6. Poverty – high rate of poverty; may be reluctant to use food stamps or feeding reluctant to use food stamps or feeding programs (welfare stigma) programs (welfare stigma)

7. Polypharmacy – Drugs, including 7. Polypharmacy – Drugs, including prescription & over-the-counter, canprescription & over-the-counter, can interact with nutrients & effect appetite interact with nutrients & effect appetite - Alcohol is the most common drug - Alcohol is the most common drug

thatthat can effect older people’s nutritioncan effect older people’s nutrition

- Medications can alter food intake, - Medications can alter food intake, nutrient absorption, metabolism &/ornutrient absorption, metabolism &/or excretionexcretion

Nutrient-Drug InteractionsNutrient-Drug Interactions



Nutrient Needs of the Nutrient Needs of the ElderlyElderly

WaterWater – risk of dehydration – risk of dehydration

1. Feel less thirsty %/or concerned1. Feel less thirsty %/or concerned

about bladder controlabout bladder control

2. Decreased % body water; less 2. Decreased % body water; less toleranttolerant

of fever and hot weatherof fever and hot weather

3. Increased risk of UTIs, pneumonia,3. Increased risk of UTIs, pneumonia,

pressure ulcers & confusionpressure ulcers & confusion

RecommendationRecommendation: 6-8 glasses water/day: 6-8 glasses water/day


EnergyEnergy – needs decrease – needs decrease ~5%/decade~5%/decade

due to:due to:

1. Lowered Basal Metabolic Rate 1. Lowered Basal Metabolic Rate ––

decreased lean body massdecreased lean body mass

2. Less physical activity2. Less physical activity

RecommendationRecommendation – select nutrient- – select nutrient-dense foodsdense foods


ProteinProtein – important to support a healthy – important to support a healthy immune system and to prevent muscle immune system and to prevent muscle wasting; high-quality, low-calorie sources, wasting; high-quality, low-calorie sources, i.e. lean meats, poultry, fish, eggs, i.e. lean meats, poultry, fish, eggs, legumes, low-fat dairy productslegumes, low-fat dairy products

Carbohydrate Carbohydrate – complex, high-fiber – complex, high-fiber sources encouraged to alleviate sources encouraged to alleviate constipation; 14 gms/1000 caloriesconstipation; 14 gms/1000 calories

FatFat – moderate intake recommended to – moderate intake recommended to enhance flavors, provide valuable enhance flavors, provide valuable nutrients, and prevent weight lossnutrients, and prevent weight loss

Nutrient Needs of the Nutrient Needs of the ElderlyElderly Vitamins & MineralsVitamins & Minerals

1. Higher Vit. D needs, esp. if home-1. Higher Vit. D needs, esp. if home- bound or little/no milk intake; bound or little/no milk intake; DRI value is 600 IU/dayDRI value is 600 IU/day 2. Iron deficiency a concern due to 2. Iron deficiency a concern due to bleeding, poor absorption, bleeding, poor absorption, medications.medications.

3. Calcium – important to protect 3. Calcium – important to protect against osteoporosis, esp. against osteoporosis, esp. postmenopausal women; problem postmenopausal women; problem if lactose- intolerant; DRI value isif lactose- intolerant; DRI value is 1200 mg/day1200 mg/day

Nutrient Needs of the ElderlyNutrient Needs of the Elderly

4. Certain “B” Vitamins (B6, B12 & folate) may fall short - Synthetic B12 supplements

recommended since intrinsic factor & hydrochloric

acid not required for digestion/absorption - Adequate intakes of Vit B6 (1.5

mg/day) recommended to help reduce homocysteine levels - Folate metabolism altered by many medications (antacids, diuretics,

NSAIDs) and alcohol

Energy And Nutrient Energy And Nutrient Needs of Older AdultsNeeds of Older Adults


Nutrient SupplementsNutrient Supplements Supplements for the ElderlySupplements for the Elderly

1. May be appropriate, esp. if consuming1. May be appropriate, esp. if consuming <1500 kcals/day; recommend an age-<1500 kcals/day; recommend an age- specific multivitamin/mineralspecific multivitamin/mineral supplement (Ex.: Centrum Silver)supplement (Ex.: Centrum Silver)

2. Supplements for specific nutrient needs 2. Supplements for specific nutrient needs due to certain diseases or health problems due to certain diseases or health problems (i.e. Vit. D & calcium for osteoporosis,(i.e. Vit. D & calcium for osteoporosis, Vit. B12 for pernicious anemia)Vit. B12 for pernicious anemia)

3. Vulnerable to advertisers claims that 3. Vulnerable to advertisers claims that products products

prevent disease and promote longevityprevent disease and promote longevity

Preventing DegenerationPreventing Degeneration

1. 1. CataractsCataracts – adequate intake of carotenoids, – adequate intake of carotenoids, Vit. C & Vit. E may help minimize oxidative Vit. C & Vit. E may help minimize oxidative damagedamage

2. 2. Arthritis Arthritis – weight loss & exercise reduces – weight loss & exercise reduces stress to jointsstress to joints

- Omega-3 fatty acids have shown benefit - Omega-3 fatty acids have shown benefit in reducing joint inflammationin reducing joint inflammation

3. 3. Brain functionBrain function – may be impaired by long- – may be impaired by long- term deficiencies of B Vitamins, Vit. C, iron &term deficiencies of B Vitamins, Vit. C, iron & zinczinc

- ? Link between aluminum & Alzheimer’s - ? Link between aluminum & Alzheimer’s

The The AgingAgingBrainBrain


Nutrition Screening and Nutrition Screening and AssessmentAssessment

Nutrition Screening Initiative – part of Nutrition Screening Initiative – part of

a national effort to identify and treata national effort to identify and treat

nutrition problems in older persons;nutrition problems in older persons;

includes Checklist, mnemonic includes Checklist, mnemonic

DETERMINE, and Level II ScreenDETERMINE, and Level II Screen

RiskRisk


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Chapter 17 Chapter 17 Nutrition for Nutrition for Adulthood & Adulthood & the Later Years the Later Years