Download Changing Nutritional Needs Throughout the Lifetime

Changing Nutritional Needs
Throughout the Lifetime
Clinical Lipid Update
National Lipid Association
New Orleans, 2013
Rebecca Reeves, DrPh,
DrPh, RD
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Outline of Talk
Healthy Habits: Healthy People 2010
 Nutrition Guidelines for
Children/Adolescents
 Nutrition Guidelines for Adults
 Nutrition
N i i Guidelines
G id li
ffor Old
Older Ad
Adults
l

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Final Report on Healthy Habits:
Healthy People 2010
Lifestyle
Habit
Baseline Year
1988--1994
1988
Healthy Weight 35%
Goal for 2010
60%
Final
2005--2008
2005
31%
Obesity (Adults) 23%
15%
34%
ObesityObesityChildren
+Adolescents
11%
18%
((BMI
<25kg/m2)
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5%
3
Status Report on Healthy Habits:
Healthy People 2010
Lifestyle Habit Baseline Year
1988--1994
1988
Fruit Intake at
39%
Goal for 2010
75%
Final
2005--2008
2005
40%
Grain Intake at
4%
least 6 S/day and
1/3 whole grain
50%
3%
Vegetables at
least 3S/day
4%
50%
4%
Saturated Fat
<10 of total
calories
36%
75%
34%
least 2 S/day
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Dietary
Guidelines for
Americans
Special Focus on
Children


Energy intake
balanced with
expenditure
More hours of
active play
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Dietary Guidelines for Americans
Special Focus on Children/Adolescents






Greatly reduce intake of sugarsugar-sweetened beverages
Increased intake of fruits and vegetables
Smaller amounts of fruit juice
Fewer meals from quick serve restaurants
Fewer hours of screen time
Regular consumption of breakfast
Report Dietary Guidelines Advisory
Committee, 2010
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Acceptable Macronutrient Ranges for
Children/ Adolescents
As Percent of Daily Energy


Carbohydrates – 45% to 65%
Protein –
Young children – 5% to 20%
 Older children – 10% to 30%


Fat
1-3 year olds – 30% to 40%
 4-18 year olds
ld – 25% to 35%

Position Academy of Nutrition and Dietetics;
Nutrition Guidance for Healthy Children,
June, 2008
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Adequate Intake of Total Fiber Per
Day

Children 11-3 years: 19gm

Children 4 to 8 years: 25 gm

Boys 99-13 years: 31 gm

Girls 99-13 years: 26 gm
Position Academy of Nutrition and Dietetics;
Nutrition Guidance for Healthy Children,
June, 2008
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Nutritional Guidelines for Children
Daily Recommended Servings
Nutritional
Guidelines
2-3 year olds
4-8 year olds
9-13 year olds
Calories
1000 kcal
1400 kcal
1600 kcal
Dairy (c)
2
2
3
Lean
2
meat/Beans (oz)
4
5
Vegetables (c)
1
1.5
2
Fruits (c)
1
1.5
1.5
Report Dietary Guideilines Advisory
Committee, 2010
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Nutritional Guidelines for Children
Daily
Dail Recommended Ser
Servings
ings
Nutritional
Guidelines
2-3 year olds
4-8 year olds
9-13 year olds
Grains (oz)
3
5
5
Oils (g)
15
17
22
Discretionary Calories
137
137
121
Report Dietary Guidelines Advisory
Committee 2010
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Nutrition Guidelines for Adults

Based on Four Sources:
Report of the Dietary Guidelines Advisory Committee, 2010
 American Heart Association , Diet and Lifestyle
Recommendations,
Recommendations 2006
 Third Report of the Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults,
 Academy of Nutrition and Dietetics, Evidence Analysis
Library, Disorders of Lipid Metabolism

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AHA Diet Recommendations




Balance calorie intake and physical activity to achieve
or maintain
i i h
healthy
lh b
body
d weight
i h
Consume a diet rich in vegetables and fruit
Ch
Choose
whole
wholeh l -grain,
i hi
high
h fib
fiber ffoods
d
Limit your intake of saturated fat <7%, trans fat to
<1% f energy andd cholesterol
<1%of
h l t l to
t <300 mg/day
/d
American Heart Association, Diet and
Lifestyle Recommendations, 2006
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AHA Diet Recommendations




Minimize your intake of beverages and foods with
added
dd d sugars
Choose and prepare foods with little or no salt
If you consume alcohol,
l h l do
d so in
i moderation
d i
When you eat food that is prepared outside of the
h
home,
ffollow
ll th
the AHA Diet
Di t andd Lifestyle
Lif t l
Recommendations
American Heart Association, Diet and
Lifestyle Recommendations, 2006
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Therapeutic Lifestyle Changes
Nutrient Composition
Nutrient
 Saturated fat
 Polyunsaturated fat
 Monounsaturated fat
 Total fat
 Carbohydrate
 Fiber
 Protein
 Cholesterol
 Total calories (energy)
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Recommended Intake
Less than 7% of total calories
Up to 10% of total calories
Up to 20% of total calories
25–
25–35% of total calories
50
50–
–60% of total calories
20–
20–30 grams per day
Approximately 15% of total calories
Less than 200 mg/day
g y
Balance energy intake and expenditure
to maintain desirable body weight/
prevent weight gain
16
Dietary Guidelines for Americans
2010
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Dietary Guidelines for Americans
2010
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Dietary Guidelines for Americans
2010
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Dietary Guidelines for Americans
2010
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Dietary Guidelines for Americans
2010
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Comparison of Three Diets to
Lower Heart Disease Risk
Food Groups
TLC NCEP
Pl
Plan
USDA Food
Pattern
DASH Plan
Fruit
2-4 servings
4- servings
4-5 servings
Vegetable
3-5 servings
5 servings
4-5 servings
Grain
>6 servings
6 servings
7-8 servings
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Comparison of Three Plans
to Lower Heart Disease Risk
Food Groups TLC – NCEP
Plan
D il Servings
Daily
S i
USDA Food
Pattern
DASH Plan
Meat/Beans
< 5 oz
< 5.5 oz
Dairyy
2-3 servings
g
3 servings
g
<6 oz, 44--5
servings nuts,
nuts
seeds, beans
2-3 servings
g
Oils/Fat
2-3 tsp.
2-3 servings
2-3 tsp
Extras
Adjust to
calorie level
258 kcal/day
5 tbsp/ week
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Total Fat



Reduce SFA to <7%
Range of 2525-35% for
lipid disorders
R
Range
off 3030-35% for
f
metabolic syndrome
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Recommendation: Major Dietary Fat Components
The cardioprotective dietary pattern should be tailored
to the individual’s needs to provide a fat intake of 252535% of calories, <7%
7% of calories from saturated fat
and trans
trans--fatty acids and <200 mg cholesterol/day.
This dietary pattern can lower LDLLDL-C up to 16% and
d
decrease
risk
i k off CHD.
CHD
Rating: Strong
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Trans Fattyy Acids



Decrease intake of trans
fatty acids to <1% of
energy
US intake approximately
pp
y
2.7% of energy
Major source in US diet
i h
is
hydrogenated
d
d fat
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Academy of Nutrition and Dietetics
Evidence Analysis Library

Recommendation for Metabolic Syndrome:

The cardioprotective dietary pattern should avoid extremes in
carbohydrate and fat intake, limits added sugar and alcohol,
and includes p
physical
y
activityy at a moderate intensityy level for at
least 30 minutes on most (preferably all) days of the week.
Weight loss of 7% to 10% of body weight should be
encouraged if indicated.
encouraged,
indicated These lifestyle changes improve risk
factors of metabolic syndrome.
Rating: Fair
Imperative

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Monounsaturated Fat


Monounsaturated fatty acids
(MUFA) are associated with
improved blood lipids
related to CVD when they
replace dietary saturated fatty
acids
5 percent energy
replacement of SFA with
MUFA decreases
i
intermediate
di markers
k andd the
h
risk of CVD
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Academy of Nutrition and Dietetics
Evidence Analysis Library

Recommendation: Replacing Saturated Fat

The Registered Dietitian (RD) should develop a nutrition
prescription within a cardioprotective dietary pattern that
replaces
p
saturated fat calories with calories from either
complex carbohydrate (CHO) principally contributed by
fruits, vegetables and whole grains, protein and/or
unsaturated fat.
fat A diet rich in omega
omega--3 fatty acids and/or
monounsaturated fat, and reduced in refined CHO may also
be effective in reducing serum triglycerides (TG) without
adverse impact on highhigh-density lipoprotein cholesterol
(HDL--C). .
(HDL

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Total Fiber



20-30 gm/day total fiber
205-10 gm soluble fiber
Soluble fiber reduces
LDL 22-5%
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Recommendation: Dietary Fiber
Include foods containing 2525-30 gm of fiber/day
/
with
special emphasis on soluble fiber sources.
sources. Risk factors
associated with CHD (blood pressure, lipoprotein
subclasses, insulin resistance) and CVD (fatal and nonnonfatal MI, stroke) are decreased as dietary fiber
i
increases.
Di t high
Diets
hi h in
i total
t t l andd soluble
l bl fiber
fib can
further reduce TC by 22-3% and LDL up to 7%.
Rating: Strong
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Plant Sterols/
Sterols/Stanols
Stanols

Dietary intake of 2
gm/day
/d will
ill lower
l
LDL--C by 6LDL
6-15%
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Recommendation: Plant Sterols/Stanols
If consistent
i
with
i h patient
i preference
f
andd not
contraindicated by risks or harms, then plant sterols
and stanol ester enriched foods consumed 22-3
times/day for a total consumption of 22-3 gm may
be used in addition to a cardioprotective diet to
further lower TC by 44-11% and LDL
LDL--C by 77--15%.
15%
Rating: Strong
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Products with Plant Sterols
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n-3 Fattyy Acids


For healthy population,
recommendation
d i iis two
fish meals/wk preferably
fatty fish
For persons with CHD
intake of EPA and DHA
is recommended at 1
gm/day (about 3 fish oil
capsules)
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Recommendation: Omega – 3 Fatty Acids
…. Omega
Omega--3
f
fatty
acids,
d preferably
f bl from
f
both
b h marine andd plant
l
sources should be included in a protective diet. Consuming
dietary sources of omegaomega-3 fatty acids from (2 -4oz
serving of fish/week
/
preferably fatty) and plantplant- based
foods of 1.5 g alpha
alpha--linolenic acids (1 tb canola, 0.5 tb
ground flax seed) are recommended. Consumption of
increased omega
omega--3 fatty acids is associated with
decreased risk of cardiac events and nonnon-fatal MI’s.
Rating: Fair
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Antioxidants


Oxidative stress appears
to be
b iinvolved
l d iin
atherogenesis
Current data do not
support taking vitamins
to lower CHD risk
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Recommendation:
Antioxidants such as Vitamins E, C, and BB-Carotene
(or carotenoids) should be specifically planned into a
cardioprotective dietary pattern.
pattern. AntioxidantAntioxidant-rich
fruits, vegetables and whole grains have been shown to
be associated with reduced disease risk.
Rating: Fair
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Recommedation:
Vitamins E, C, and BB-carotene supplements should not
be recommended to reduce the risk of CVD.
Th supplements
These
l
have
h
shown
h
no protection
i ffor
CVD events or mortality.
Rating: Strong
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Recommendation:
Folate,vitamins B6 and 12 should be planned into the
cardioprotective dietary pattern to meet the DRI. If an
individual has high serum homocysteine levels (usually
> 13 umol/l)
umol/l) these B vitamins may lower serum
homocysteine
y
levels.
Rating: Fair
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Academy of Nutrition and Dietetics
Evidence Analysis Library
Supplemental folate given alone or in combination with
B6 andd B12 may or may not be
b beneficial.
b fi i l Research
R
h
has shown that after six months to two years
supplemental folate and B
B--vitamins did not reduce the
risk for coronary events.
Rating: Weak
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Nuts

Consumption of 5
ounces off nuts per weekk
is associated with
reduced risk of CHD
CHD.
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Academy of Nutrition and Dietetics
E id n Analysis Library
Evidence


Nuts (walnuts, almonds, peanuts, macadamia, pistachios, and
pecans) may be isocalorically incorporated into a
cardioprotective dietary pattern. Consuming five ounces of
nuts per week is associated with a reduced risk of CHD.
Because of their beneficial fatty acid profile as well as other
nutritional components, nuts may be incorporated into a
cardioprotective
p
dietaryy pattern
p
low in saturated fat and
cholesterol to reduce TC by 44-21% and LDLLDL-C by 66-
29%.
Fair, Conditional
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Herbal Supplements
pp

Paucity of data exists to
recommendd h
herbal
b l or
botanical dietary
supplements to prevent
CHD
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Chocolate, Coffee and Cocktails
Review of 10 previous studies
p
of chocolate consumption
and cholesterol reports that
the cocoa found in dark
chocolate is linked to
significant
i ifi
reductions
d i
in
i totall
and LDL (“bad”) cholesterol
Dark chocolate was linked to
average
r
rreductions
d ti
off 66.23
23
mg/dL in total cholesterol
and 5.9 mg/dL in LDL.
European Journal of Clinical Nutrition 65,
879-886 (August 2011)
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Chocolate, Coffee and Cocktails


Data from over 400,000
people in the NIH AARP
Diet and Health Study
showed that those who
drank coffee were less likely
to die than non coffee
drinkers.
The more they drank (up to
6 cups) the less likely they
di d over 13 years off the
died
h
Freedman ND, et. al. The Association of
study
Coffee Drinking with Total and CauseSpecific Mortality, NEJM, May 17, 2012.
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Coffee, Chocolate and Cocktails


Moderate intake of alcohol
in middle
middle--aged and older
adults may reduce risk for
CHD.
No more than two
drinks/day for men and one
drink/day for women
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Academy of Nutrition and Dietetics
Evidence Analysis Library

Recommendation:
If a patient currently drinks alcohol, and if not
contraindicated, then a maximum of one drink /day for
women and up
p to two drinks/
/ dayy for men mayy be
incorporated into a cardioprotective dietary pattern within
recommended calorie levels.
Th is
There
i no evidence
id
that
h one type off alcohol
l h l iis b
better than
h
another
Rating:
g Fair
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My Plate for Older Adults
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Additional Recommendations for
Older Adults


Vitamin B12:
B12: An estimated 66-15% of older adults have
vitamin B12 deficiency and approximately 20% may
have marginal levels. Food intake should meet the DRI
and if food intake is low, a multivitamin mayy be
suggested
Protein:: For most older adults, 0.8 gm/kg
Protein
gm/kg /day is
adequate but 2525- 30 gm of high quality protein at each
meal is now suggested (1 oz low fat meat = 8 gm of
protein)
pr t i )
Position of Academy of Nutrition and
Dietetics:Food and Nutrition Older Adults. J
Acad Nut Diet.2012.
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Additional Recommendations for
Older Adults

Fiber: Dietary fiber intake is in older adults is lower
than
h recommended
d d llevels.
l R
Recommended
d d ddaily
il llevels
l
for adults 50 – 70 years old are
Males – 30 gm
 Females – 21 gm


Fluids :
Males 5050-70 years old - 3.7 L/day
 Females 50 - 70 y
years old – 2.7 L/dayy

Position of Academy of Nutrition and
Dietetics:Food and Nutrition Older Adults. J
Acad Nut Diet.2012.
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