Download Perspectives in Nutrition, 8th Edition

Perspectives in Nutrition, 8th Edition
Chapter 18 Outline: Nutrition During the Adult Years
After studying this chapter, you will be able to:
1. Describe the hypotheses about the causes of aging.
2. Discuss the factors that affect the rate of aging.
3. Explain how the basic concepts that underlie the 2005 Dietary Guidelines for Americans relate to
adult health.
4. Describe how physical and physiological changes that occur during adulthood affect nutritional
needs.
5. Compare the dietary intake of adults with the current recommendations.
6. Discuss the effects of physical, physiological, psychosocial, and economic factors on the food
intake and nutrient needs of adults.
7. Describe community nutrition services for older persons.
8. Identify nutrition-related health issues of the adult years and describe the prevention and
treatment of these health problems.
9. List the potential benefits and risks associated with the use of complementary and alternative
medicine practices.
18.1
Physical and Physiological Changes during Adulthood
A.
General
1.
Adulthood spans from completion of physical growth at the end of adolescence
through death
2.
Nutrients are used for body maintenance rather than physical growth
3.
Food and Nutrition Board divides adulthood into four stages
a.
Young adulthood:
i.
19 - 30: body systems operate at peak efficiency
ii.
31 - 50: rate of cell breakdown slowly begins to exceed rate of
cell renewal, leading to gradual decline in organ size and
efficiency
b.
Middle adulthood: 51 - 70
c.
Older adulthood: 70+
4.
Aging: time-dependent physical and physiological changes in body structure and
function that occur normally and progressively throughout adulthood as humans
mature and become older
5.
Reserve capacity: extent to which an organ can preserve normal function despite
decreasing cell number or activity
6.
Decreased capacity causes problems when severe demands are placed on the
body
7.
Aging is likely the sum of automatic cellular changes, lifestyle practices, and
environmental influences
8.
Proposed causes of aging (see Table 18-1)
B.
C.
a.
Errors in DNA
b.
Stiffening of connective tissue
c.
Oxidative damage by free radicals
d.
Hormone function changes
e.
Immune system insufficiency
f.
Development of autoimmunity
g.
Glycosylation of proteins
h.
Programmed cell death
i.
Excess energy intake
9.
Some changes of aging are inevitable, but many degenerative age-related
changes can be minimized, prevented, and/or reversed by healthy lifestyle
practices and avoiding adverse environmental factors
Usual and Successful Aging
1.
Usual aging: expected age-related physical and physiological changes, many of
which are actually the results of unhealthy lifestyle choices, adverse
environmental exposures, and chronic diseases
a.
Increasing body fatness
b.
Decreasing lean mass
c.
Rising blood pressure
d.
Declining bone mass
e.
Increasingly poor health
2.
Successful aging: physical and physiological function declines that occur only
because of advancing years, not due to lifestyle choices, environmental
exposures, or chronic diseases
3.
Compression of morbidity: maximizing healthy years and minimizing illness;
delayed onset of chronic diseases
Factors Affecting the Rate of Aging
1.
Heredity
a.
Longevity is somewhat genetically determined
b.
Females liver longer than males
c.
Thrifty metabolism
i.
Requires fewer calories for metabolic processes
ii.
Stores fat more easily
iii.
Leads to obesity and chronic disease with overabundance of food
and sedentary lifestyle
d.
Rate of HDL cholesterol production
i.
Genetic ability to produce abundant HDL may decrease risk of
CVD
ii.
Reduced ability to produce HDL leads to premature death and
shorter life
e.
Lifestyle and environment can modify expression of genetic potential
2.
Lifestyle
a.
Food choices
3.
18.2
b.
Exercise patterns
c.
Substance use
Environment
a.
Income
b.
Education level
c.
Health care
d.
Shelter
e.
Psychosocial factors
Nutrient Needs during Adulthood
A.
2005 Dietary Guidelines for Americans
1.
Consume a variety of nutrient-dense foods and beverages from the basic food
groups of MyPyramid that result in a diet low in saturated and trans fat,
cholesterol, added sugars, salt, and alcohol
2.
Maintain body weight in a healthy range by balancing energy intake with
expenditure (at least 30 minutes of moderate-intensity physical activity above
usual activity on most days of the week)
3.
Practice safe food handling
B.
Benefits of good nutrition
1.
Delay onset of certain diseases
2.
Improves management of existing diseases
3.
Speed recovery from illnesses
4.
Increases mental, physical, and social well-being
5.
Decreases need for and length of hospitalization
C.
Common dietary excesses and inadequacies
1.
Excess calories, fat, sodium, alcohol
2.
Inadequate vitamins D and E, folate, magnesium, calcium, zinc, and fiber (and
iron for women before menopause)
D.
DETERMINE Checklist (Nutrition Screening Initiative)
1.
Disease
2.
Eating poorly
3.
Tooth loss or mouth pain
4.
Economic hardship
5.
Reduced social contact and interaction
6.
Multiple medications
7.
Involuntary weight loss or gain
8.
Need for assistance with self-care
9.
Elder at advanced age
E.
Defining Nutrient Needs
1.
Calories
a.
After age 30, calorie needs of physically inactive adults fall throughout
adulthood due to gradual decline in basal metabolism
b.
Exercise can halt, slow, or reverse reductions in lean body mass
2.
3.
4.
5.
6.
Protein
a.
Adult protein intake exceeds recommendations
b.
Consuming protein slightly in excess of RDA may help preserve muscle
and bone mass
c.
Risk for inadequate protein intake
i.
Limited food budget
ii.
Chewing difficulties
iii.
Lactose intolerance
d.
Excess protein intake contributes to energy storage and may accelerate
kidney function decline
Fat
a.
Adult fat intake exceeds current recommendations
b.
Reducing fat intake cuts risk for overweight, obesity, and chronic disease
c.
Seek more nutrient-dense foods to meet nutrient needs
Carbohydrates
a.
Adult carbohydrate intake may be lower than recommendations
b.
Emphasize complex carbohydrates and fiber; decrease simple
carbohydrates
i.
Meet nutrient needs
ii.
Regulate blood glucose
iii.
Reduce risk of colon cancer and heart disease
iv.
Lower blood cholesterol
v.
Avoid constipation
c.
Typical fiber intake is ½ of recommendation
Water
a.
Many older adults consume inadequate fluids
b.
Causes of low fluid intake in older adults
i.
Decreased sense of thirst
ii.
Chronic disease
iii.
Conscious reduction to reduce frequency of urination
iv.
Fluid restrictions due to medications, ostomy, or kidney disease
c.
Consequences of inadequate fluid intake
i.
Mild dehydration
ii.
Electrolyte imbalances
iii.
Disorientation and mental confusion
iv.
Constipation, fecal impaction
v.
Death
Minerals and Vitamins
a.
Calcium and Vitamin D
i.
Tend to be low for all adults, but especially problematic for
adults over age 50
ii.
Inadequate intake
iii.
Reduced absorption of calcium
iv.
v.
vi.
vii.
viii.
ix.
x.
b.
Iron
i.
ii.
iii.
c.
d.
e.
Zinc
i.
ii.
iii.
Reduced synthesis of vitamin D by the skin
Decreased ability of kidneys to convert vitamin D to active
hormone
Contributes to development of osteoporosis
Food sources of vitamin D are limited; major sources (e.g., fatty
fish, fortified milk) are not widely consumed by older adults
Lactose intolerance prevents consumption of calcium-rich dairy
products among many older adults, but consuming small
amounts of milk at mealtime is usually well tolerated
To meet calcium needs, older adults should consume calciumfortified foods, cheese, yogurt, fish with bones, dark green leafy
vegetables
10 - 15 minutes per day of sunlight can improve vitamin D status
Iron deficiency anemia is most common among women during
reproductive years
Anemia may also result from GI tract injuries that cause bleeding
(e.g., ulcers, hemorrhoids) and use of medicines that cause blood
loss (e.g., aspirin)
Iron absorption may be impaired due to atrophic gastritis, which
decreases HCl production
Suboptimal dietary intake
Zinc absorption declines as stomach acid production decreases
Leads to loss of sense of taste, mental lethargy, and delayed
wound healing
Magnesium
i.
Suboptimal dietary intake
ii.
Leads to loss of bone strength, muscular weakness, mental
confusion, abnormal heart rhythm,
iii.
Linked to CVD, osteoporosis, and DM
iv.
Dietary sources are preferred; supplements can cause diarrhea
Folate and Vitamins B-6 and B-12
i.
For women during childbearing years, adequate folate status
decreases risk for NTDs
ii.
In middle and older adulthood, adequate folate, B-6, and B-12
are required to metabolize homocysteine; hyperhomocysteinemia
is associated with CVD, stroke, bone fracture, and neurological
decline
iii.
Vitamin B-12 deficiency may exist despite adequate dietary
intake due to poor absorption (decreased stomach production of
acid and intrinsic factor)
iv.
7.
18.3
Adults age 51+ likely need fortified foods and supplements
containing synthetic B-12
f.
Vitamin E
i.
Suboptimal dietary intake
ii.
Reduces antioxidant capabilities; increased oxidative damage
may lead to chronic diseases, cataracts, and speed the aging
process
Carotenoids
a.
Lutein and zeaxanthin protect against cataracts and age-related macular
degeneration
b.
Diets high in fruits and vegetables supply carotenoids and other
beneficial phytochemicals
Factors Influencing Food Intake and Nutrient Needs
A.
Physical and Physiological Factors (see Table 18-2)
1.
Body Composition
a.
Sarcopenia: gradual, steady decline in lean body mass decreases basal
metabolic rate, muscle strength, and energy needs
b.
Decline in body water
c.
Increase in fatty tissue
d.
Redistribution of body fat from limbs to torso increases risk for chronic
diseases
e.
Physically active lifestyle (including aerobic exercises, strength training,
and balance exercises) can maintain muscle mass
f.
Weight loss with aging increases risk of malnutrition and death
2.
Skeletal System
a.
Slow, steady loss of bone minerals (especially after menopause in
women) may lead to osteoporosis
b.
Osteoporosis limits ability to shop and prepare food, thereby
complicating nutritional status
c.
Practices that preserve bone health
i.
Adequate vitamin D, calcium, and protein intake
ii.
Moderate alcohol intake
iii.
Avoidance of smoking
iv.
Engaging in weight-bearing activity
v.
Medications
3.
Cardiovascular System
a.
Gradual decrease in delivery of oxygen and nutrients to body cells and
removal of metabolic wastes
b.
Hypertension
c.
Practices that preserve cardiovascular function
i.
Remain physically active
ii.
Avoid smoking
4.
5.
6.
7.
iii.
Consume low-fat, nutrient-rich diet
iv.
Moderate sodium intake
Respiratory System
a.
Decreased lung capacity limits body function, physical activity, eating
b.
Emphysema and lung cancer
c.
Practices that preserve respiratory function
i.
Avoid smoking
ii.
Consume antioxidant-rich diet
iii.
Physical activity
Digestive System
a.
Diminished chewing ability (e.g., gum disease, tooth loss)
b.
Declines in digestion and absorption due to diminished HCl, intrinsic
factor, and enzymes
c.
Functions of accessory organs decline
i.
Decreased ability of liver to metabolize alcohol and drugs;
increased risk of vitamin or mineral toxicity
ii.
Gallbladder disease interferes with fat digestion
iii.
Declining pancreatic function may decrease digestion of
nutrients and complicate blood glucose control
d.
Slowed motility leads to constipation and hemorrhoids
e.
Practices that preserve digestive function
i.
Consume adequate fiber and fluids
ii.
Physical activity
iii.
Possible use of fiber supplements, stool softener, or laxative
iv.
Avoid vitamin and mineral megadoses
v.
Low-fat diet
vi.
Maintain healthy weight
vii.
Routine dental hygiene and care
viii.
Serve soft, easy-to-chew foods; allow extra time for chewing and
swallowing
Urinary System
a.
Decreased kidney function impairs filtration of metabolic wastes and
ability to concentrate urine
b.
Decreased ability to convert vitamin D to active form
c.
Weakening of muscles that control urination
d.
Practices that preserve urinary system function
i.
Avoid excess protein intake
Nervous System
a.
Decreased sensory perceptions
b.
Slowed reaction times
c.
Impaired coordination, reasoning, and memory
d.
Nervous system changes lead to social isolation and impair ability to
shop for, prepare, and consume nutrient-dense foods
e.
8.
9.
10.
11.
12.
Practices to preserve nervous system function
i.
Consume diet rich in fruits and vegetables to reduce risk of
macular degeneration and cataracts
Immune System
a.
Increased susceptibility to infection and disease
b.
Practices that preserve immune function
i.
Consume adequate protein, folate, vitamin A, vitamin D, vitamin
E, iron, and zinc
ii.
Avoid obesity
iii.
Avoid excessive fat, iron, and zinc intakes
Endocrine System
a.
Glucose intolerance or diabetes
b.
Slowed metabolic rate due to declines in thyroid hormone
c.
Loss of lean body mass and thinning skin due to declines in growth
hormone
d.
Practices that preserve endocrine function
i.
Maintain healthy weight
ii.
Exercise regularly
iii.
Consume low-fat, high-fiber, low-GI diet
Reproductive System
a.
Females: declines in estrogen after menopause
i.
Iron needs drop
ii.
Increased risk of CVD and osteoporosis
b.
Males: slow declines in testosterone after age 60
i.
Decreased lean body mass diminishes calorie needs
Chronic Disease
a.
Prevalence of obesity, heart disease, osteoporosis, cancer, hypertension,
and DM increase
i.
8 of 10 elderly adults have at least 1 chronic disease
ii.
Half of older adults have at least 2 chronic diseases
b.
Impaired physical function may decrease ability to shop for, prepare, and
consume nutrient-dense foods
c.
Chronic diseases may affect nutrient and calorie needs and utilization
i.
Cancer boosts nutrient and calorie needs
ii.
Hypertension may require lower sodium intake
iii.
Diabetes alters glucose utilization
iv.
Kidney disease affects retention of glucose, amino acids, and
vitamin C
Medications
a.
Half of older adults practice polypharmacy
b.
Half of older adults use daily supplements
c.
Effects of medications and supplements may be exaggerated and more
persistent among older adults
d.
B.
C.
D.
Some medications adversely affect nutrition status
i.
Depress taste and small
ii.
Cause anorexia
iii.
Aspirin increases risk of stomach bleeding, which may elevate
iron needs
iv.
Antibiotics may deplete vitamin K
v.
Diuretics and laxatives may cause excessive excretion of water
and minerals
vi.
High doses of minerals affect absorption of other minerals
e.
Some nutrients interact with medications
i.
Vitamin K alters action of oral anticoagulants
ii.
Aged cheese can affect action of hypertension and depression
medications
iii.
Grapefruit can interfere with tranquilizers and cholesterollowering medications
Psychosocial Factors
1.
Apathy and depression may lead to changes in appetite and food intake
2.
Depression is diagnosed in about 15% of older adults
3.
Social isolation diminishes food intake
Economic Factors
1.
Unemployment, underemployment, retirement, or other factors that limit income
restrict ability to obtain nutritious foods
2.
Nutrition assistance programs are available
Table 18-5 presents guidelines for healthful eating in later years
1.
Eat regularly
2.
Eat with others
3.
Eat in well-lit or sunny area; serve attractive meals; vary flavors, colors, shapes,
textures, and smells
4.
Exercise before eating to stimulate appetite
5.
Arrange kitchen for easy food preparation and cleanup
6.
Use labor-saving equipment and foods
7.
Try new things
8.
Keep easy-to-prepare foods on hand
9.
Share cooking responsibilities with neighbor
10.
Add dry milk to increase nutrients in mixed dishes
11.
Cook large amounts and freeze small portions
12.
Chop, grind, or blend hard-to-chew foods; serve soft foods
13.
Cut foods ahead of time; obtain specialized utensils
14.
Use community resources to obtain meals
15.
Buy only what can be used
16.
Break family-size packages into smaller portions
17.
Buy produce at varied stages of ripeness
18.
Meal replacement bars or formulas
19.
Stay physically active
18.4
Nutrition Assistance Programs
A.
USDA administers several assistance programs
1.
Commodity Supplemented Food Program distributes surplus agricultural
products to low-income households at no charge
2.
Food Stamp Program provides nutrition education and vouchers to purchase
foods, plants, seeds, some meals at shelters and restaurants
3.
Child and Adult Care Food Program provides nutritious meals and snacks to lowincome children in child-care centers or emergency shelter or adults in nonresidential adult day-care centers
4.
Senior Farmers’ Market Nutrition Program provides coupons for fresh fruits,
vegetables, and herbs at farmers’ markets, roadside stands, and other communitysupport agriculture programs
B.
U.S. Administration on Aging administers Older Americans Act, which helps older adults
maintain independence
1.
Adult day care
2.
Senior center activities
3.
Transportation
4.
Information
5.
Counseling services
6.
Health and physical activity programs
7.
In-home care
8.
Elderly Nutrition Program provides nutrition services
a.
Congregate Meal Program
b.
Home Delivered Meal Program
c.
Shopping assistance
d.
Counseling
e.
Nutrition education
f.
Referrals to social, rehabilitative, and transportation services
18.5
Nutrition-Related Health Issues of the Adult Years
A.
Alcohol Use
1.
Consequences of alcohol use and abuse are magnified with advancing age
a.
Faster intoxication due to slower metabolism of alcohol and decreased
body water
b.
Interactions with medications
c.
Increased risk of stroke
d.
Aggravated hypertension
2.
Adults over age 65 should limit alcohol intake to 1 drink/day
3.
Alcohol abuse
a.
May arise from loneliness, social isolation, death of spouse
b.
Symptoms may be disregarded as part of normal aging
B.
C.
i.
Trembling hands
ii.
Sleep problems
iii.
Memory loss
iv.
Unsteady gait
Slowed Restoration of Homeostasis
1.
Slower kidney function
2.
Slower metabolism of alcohol, drugs, and supplements by liver
3.
Increases vulnerability to illness and death
4.
Prudent lifestyle choices to preserve optimal body system function
a.
Prophylactic measures (e.g., flu shots)
b.
Avoid excessive protein intake
c.
Get prompt medical attention for illness or injury
d.
Avoid stress
Alzheimer’s Disease
1.
Irreversible, abnormal, progressive deterioration of the brain that leads to loss of
memory, reasoning, and comprehension
2.
10 warning signs
a.
Recent memory loss that affects job performance
b.
Difficulty performing familiar tasks
c.
Problems with language
d.
Disorientation to time and place
e.
Faulty or decreased judgment
f.
Problems with abstract thinking
g.
Tendency to misplace things
h.
Changes in mood or behavior
i.
Changes in personality
j.
Loss of initiative
3.
Potential causes
a.
Altered cell development or protein production in brain
b.
Strokes
c.
Altered lipoprotein composition
d.
Obesity
e.
DM
f.
Hypertension
g.
High cholesterol
h.
Oxidative stress
4.
Prevention
a.
Maintain brain activity through lifelong learning
b.
Diet rich in fruits and vegetables (provides antioxidants)
c.
Use of ibuprofen
d.
Adequate folate, B-6, and B-12 to decrease homocysteine levels, which
are a risk factor for Alzheimer’s disease
e.
D.
18.6
Diets rich in essential fatty acids and low in saturated and trans fats
reduce risk of Alzheimer’s disease
5.
Disease complicates nutritional status due to poor food intake
6.
Dietary recommendations
a.
Monitor weight
b.
Serve omega-3 rich fish twice per week
c.
Avoid choking hazards
d.
Regular physical activity
Arthritis
1.
Disease that causes degeneration and roughening of cartilage that covers and
cushions joints and/or formation of calcium deposits (spurs), leading to inflamed
and painful joints
2.
Osteoarthritis is leading cause of disability among older adults
3.
Rheumatoid arthritis is more prevalent in younger adults
4.
No special diet, food, or nutrient has been proven to prevent, relieve, or cure
arthritis
5.
Maintenance of healthy weight offers relief
Medical Perspective: Complementary and Alternative Medicine Practices
A.
A Closer Look at Herbal Therapy
1.
Should be used with caution, preferably under physician supervision
a.
Some are harmless, some are toxic, some may be effective
b.
Interactions between alternative therapies and pharmaceuticals are
possible and can be drastic
c.
Mislabeling, adulteration, or varied potency are possible
2.
Herbal products should be avoided by some groups
a.
Pregnant or nursing women
b.
Anyone with chronic diseases
c.
Children under age 2
3.
Examples (see Table 18-6)
a.
Black cohosh may reduce postmenopausal symptoms
b.
Coenzyme Q-10 may reduce oxidative stress in people with chronic
conditions
c.
Echinacea may stimulate immune system; studies show little or no effect
d.
Feverfew may reduce pain and frequency of migraines
e.
Garlic may have antibiotic, cholesterol-lowering, or blood pressurelowering properties
f.
Ginger may prevent motion sickness and nausea related to surgery and
pregnancy
g.
Gingko biloba may increase circulation, particularly to brain and lower
extremities; evidence is very weak
h.
Ginseng may decrease weakness and fatigue and increase resistance to
stress; studies do not confirm benefit
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
Glucosamine may decrease joint inflammation associated with
osteoarthritis, but recent large clinical trial showed no benefit
Milk thistle may protect liver
SAMe may promote cartilage formation and decrease joint inflammation
and pain of osteoarthritis; may act as mild antidepressant
St. John’s wort has mild antidepressant effect that may work by
inhibiting monoamine oxidase, which destroys serotonin, epinephrine,
and dopamine
Saw palmetto may reduce symptoms of enlarged prostate gland; some
studies show moderate effectiveness, others show no benefit
Valerian: may alleviate restlessness and other sleeping disorders
DHEA converts to estrogen and testosterone; taken to aid weight loss or
treat depression, but benefits of supplementation are unproven
Growth hormone stimulates cell synthesis; may be useful with GH
deficiencies
Melatonin may aid sleep and reduce jet lag
Testosterone affects muscle mass and strength, can reduce menopausal
symptoms in women and possibly depression in older men