Nutrition During the Adult Years

Chapter 18

2

Learning Outcomes

• Discuss the factors that affect the rate of aging

• Describe how physical and physiological changes that occur during adulthood affect nutrition needs

• Know the current nutrition recommendations for elderly adults

• Describe community nutrition services for older persons

3

Learning Outcomes

• Identify nutrition-related health issues of the adult years and describe the prevention and treatment of these health problems

• Lists the potential benefits and risks associated with the use of complementary and alternative medicine practices

THE AGING OF AMERICA

Older Population by Age: 1900-2050 - Percent 60+, Percent 65+, and 85+

0%

5%

10%

15%

20%

25%

30%

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

% 60+ % 65+ % 85+

• So the good news is, Americans live longer than ever before- which is reflected in this graph. Those shows the % of the population made up by 60 yo, 65 yo, and 85 yo from 1900 and projected to 2050.

• This graph suggests that over 60 is “older”

http://www.cdc.gov/aging/

WHAT AGE IS CONSIDERED ELDERLY?

4262

89

50

71

WHAT AGE IS CONSIDERED ELDERLY?

• No single, chronological timetable of human aging exists.

• Genetics, lifestyle, and disease processes affect the rate of aging

• Assessment of nutritional risk depends on a variety of factors• Separate nutrition recommendations for 51-70 and 70+• Assess overall health, quality of life

LEADING CAUSES OF DEATH IN US (CDC)

• Heart disease: 616,067• Cancer: 562,875• Stroke (cerebrovascular diseases): 135,952• Chronic lower respiratory diseases: 127,924• Accidents (unintentional injuries): 123,706• Alzheimer's disease: 74,632• Diabetes: 71,382• Influenza and Pneumonia: 52,717• Nephritis, nephrotic syndrome, and nephrosis: 46,448• Septicemia: 34,828

AS WE AGE…

• Around age 25–30 the average maximum attainable heart rate declines by about one beat per minute, per year

• Heart’s peak capacity to pump blood drifts down by 5%–10% per decade.

• This diminished aerobic capacity can produce fatigue and breathlessness with modest activity.

AS WE AGE…

• Starting in middle age blood vessels begin to stiffen and blood pressure often creeps up.

• Blood becomes more viscous and harder to pump through the body, even though the number of oxygen-carrying red blood cells declines.

• Nutrition recommendations: low sodium diet (1500-2000 mg/day) with potassium rich foods (DASH), omega 3’s found in fish help thin blood

AS WE AGE…

• Blood sugar levels rise by about 6 points per decade, making type 2 diabetes distressingly common in elderly.

• Nutrition recommendations: avoid excess weight gain, encourage activity

AS WE AGE…

• In men, testosterone declines by about 1% per year after the age of 40 leading to a drop in muscle mass and bone density.

• In women bone loss mainly occurs after menopause (estrogen loss)

• Nutrition recommendations:• Calcium requirements increase (from 1000mg to

1200 mg after age 50 in women, 1200 mg after age 70 in men)

• Vitamin D requirements increase (from 15 ug/d to 20 ug/d after age 70)

AS WE AGE…

• Slowing of the digestive tract, decreased digestive secretions

• Dietary changes, activity changes, and medications can also play causal role

• Nutrition recommendations:• Increased fiber needs, 21 g for women and

30 g for men• Diet that includes nuts, fruits, veg, and whole grains

should provide fiber needs• Fluid, exercise can also help constipation

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• Sensory changes• Sight (fear of cooking, trouble shopping, reading labels,

reading menus)• Carotenoids (lutein, zeaxanthin, beta caroteine) may prevent

retinal degeneration• Carotenoids and C and E may prevent macular degeneration• Vitamin C can prevent cataracts

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• Sensory Changes• Change in taste, smell

• Nutrition recommendations• Ensure adequate intake of zinc• Try and variety of new flavors, experiment with different

types of low sodium seasonings• Don’t over cook food

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• Structural changes• Loss of lean mass

• Decreased RMR• Too many calories for decreased RMR results in

increased fat• This extra fat contributes to a rise in LDL cholesterol

and a fall in HDL cholesterol• Nutrition recommendations: • Protein needs 0.8g/kg depending on disease state• Activity• Heart healthy diet low in saturated fat and trans fat

and with nutrient dense foods to prevent weight gain

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• Loss of body water• 72% of total body water is in lean muscle• Can lose sense of thirst, forgetting to drink, frequent

urination due to meds• Recommend 5-8 cups fluid daily

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• About 30% of older people in N. America have lost all their teeth

• Nutrition recommendations:• Focus on nutrient dense foods• May need soft, moist forms of protein (ground

meat, tofu, beans, eggs, tuna, etc)

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• 20% of nursing home residents and 5-10% of older people outside of nursing homes suffer from depression

• Other barriers to healthy eating include financial barriers, difficulty cooking for one, limited resources for shopping and preparing food

• Adequate social support and possibly psychological interventions are important

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• 1/3 of alcohol abuse begins later in life• Due to more free time, loneliness,

depression, more social events with alcohol• Older adults have less body water to

distribute alcohol and metabolize alcohol slower

• Alcohol can deplete B vitamins • Nutrition recommendations• Men and women over 65 should limit

alcohol to 1 drink/day (12 oz beer, 1.5 oz shot, 5 oz wine)

WHY ARE THE ELDERLY AT RISK FOR MALNUTRITION

• Increased risk of food borne illness due to• Weaker immune systems • Decreased stomach acid needed to control bacteria.

PREVENT FOOD BORNE ILLNESS• Raw, rare or undercooked meats, poultry, and fish

(rare hamburgers and beef or steak tartare, sushi)• Undercooked and raw shellfish (clams, oysters,

mussels and scallops)• Unpasteurized dairy products, fruit and vegetable

juice ("raw" milk and cheeses)• Raw or undercooked eggs (soft-cooked, runny or

poached)

• Washing hands, washing counters where raw meat was handled, proper thawing, not using expired products

MEDICATION INTERACTIONS

• ¼ of elderly adults take multiple prescription medications

• Different medications can affect appetite, absorption of nutrients

• Some medications cannot be taken with certain foods and certain foods can interfere with their action

NUTRITION NEEDS CHANGE

• Iron-too much iron is a pro oxidant, only supplement if iron deficiency anemia

• DRI for women 51+ decreases to 8 mg• B12 is common deficiency due to

decreased gastric acid (needed to free B12 from food)

• Deficiency associated with pernicious anemia, nerve damage, cognitive decline

• DRI is 2 ug/d (no change), however supplements or fortified foods are better absorbed than B12 in food

NUTRITION NEEDS CHANGE• Vitamin B6 requirement is increased with

advancing age, although the reasons for this are uncertain

• Deficiency can lead to irritability, depression, and confusion; additional symptoms include inflammation of the tongue, sores or ulcers of the mouth

• Anti-Parkinson drugs form complexes with vitamin B6 and thus create a functional deficiency.

• DRI increases from 1.1 mg to 1.4 mg in men and 1.3 mg in women after age 50

NUTRITION NEEDS CHANGE

• Calcium and vitamin D insufficiency can lead to increased risk of osteoporosis.• A decrease in the intestinal absorption of calcium • The kidneys are less able to retain calcium, leading to increased urinary calcium loss • Less frequent exposure to sunlight • A decrease in the capacity of the skin to synthesize vitamin D • A decrease in the capacity of the kidneys to convert vitamin D into the most active form, 1,25-dihydroxyvitamin D • Calcium requirements increase (1200 mg after

age 50 in women, 1200 mg after age 70 in men)• Vitamin D requirements increase (20 ug/d after

age 70)

PROGRAMS

• Congregate dining• Home delivered meals• Food stamps• The Senior Farmers' Market Nutrition Program

(SFMNP) provides low-income seniors with coupons that can be exchanged for foods at farmers' markets, roadside stands, and community supported agriculture programs.

http://www.ssa.gov/pubs/10100.html

RECOMMENDATIONS

“If exercise were a pill it would be the most prescribed medication in the world”

THE DALLAS BED REST AND TRAINING STUDY

• In 1966, five healthy 20 yo men spent three weeks on bed rest

• They developed many physiologic characteristics of men twice their age (faster resting heart rates, higher blood pressures, a drop in the heart’s maximum pumping capacity, a rise in body fat, and a fall in muscle strength)

• After an 8-week exercise program the deterioration had reversed and some measurements were better than after the training.

Taken from the Harvard Health newsletter www.health.harvard.edu/newsweek/exercise_and_aging

THE DALLAS BED REST AND TRAINING STUDY

• The original subjects all agreed to be evaluated again at the age of 50.

• Over the years, the men gained an average of 50 pounds.

• Their average body fat doubled from 14% to 28% of body weight.

• There was a rise in resting heart rate and blood pressure and a fall in maximum pumping capacity.

Taken from the Harvard Health newsletter www.health.harvard.edu/newsweek/exercise_and_aging

THE DALLAS BED REST AND TRAINING STUDY

• After six months of endurance training, the men averaged a modest 10-pound loss of their excess weight, but their cardiovascular function and blood pressure was the same as age 20.

Taken from the Harvard Health newsletter www.health.harvard.edu/newsweek/exercise_and_aging

RECOMMENDATIONS FOR EXERCISE

• Endurance exercise improves cardiovascular function, lowers blood pressure, protects against wt gain, improves insulin sensitivity, improve cholesterol. Recommendation is 30 min+ most days of the week.

• Resistance exercise and flexibility training 20 minutes two or three times a week

• Exercises for balance will help avoid injuries and

prevent the falls

HOW TO AGE WELL• Exercise • Eat properly for heart health and weight

management• May need supplemental calcium, D, and B12• Drink plenty of water• Limit to 1 alcoholic drink a day• Keep the mind active and stimulated• Build strong social networks• Get regular medical care

NUTRITION PRODUCTS TARGETED TO ELDERLY

• Multivitamins for people over 50• No iron• Extra D, B12, and B6• Added lutein and lycopene

• Vitamins for memory• Omega-3 • Vitamin B-12 and B-6 • Vitamin D-3 • Meal replacement products

• Protein Drinks• 300-350 kcal, 10-20 grams protein, low saturated fat 

CENTENARIANS

• There are more centenarians per capita in Okinawa, Japan than anywhere else in the world.

• Typical diet is filled with tofu, whole grains, vegetables, and fish.

• They eat very little meat and dairy. • They only eat to the point where they are

about 80% full. • They practice martial arts exercises, and

generally have a positive spiritual attitude, and a low-stress way of living

From Okinawa Centenarian Study http://www.okicent.org

COMPREHENSIVE ASSESSMENT OF LONG-TERM EFFECTS OF REDUCING INTAKE OF

ENERGY

• CALERIE is the first study to investigate prolonged calorie restriction in healthy humans

• A smaller predecessor study ended in 2006. Forty-eight subjects were randomly assigned to a control group and a treatment group; those in the treatment group were put on a 25% calorie reduced over a 6 month period.

• It was found that the treatment group had less insulin resistance, lower levels of LDL cholesterol, lower body temperature and blood-insulin levels as well as less oxidative damage to their DNA.

• The second, larger, phase of CALERIE began in 2007. The participants are subjected to a 25% calorie restriction over a 2-year period.

Das SK et al. American Journal of Clinical Nutrition; 2007