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Chapter 16

NUTR 2050 Chapter 16: Chapter 16

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NUTR 2050
Dalia El Khoury

Thursday, February 2, 2017 Chapter 16: Adult Nutrition Introduction adulthood is divided into: • early adulthood - twenties involve: becoming independent, leaving parental home, finishing school, starting career, developing relationships - thirties involve: increasing responsibility for others, having children, building career, involvement in community • midlife - forties involve: active family responsibilities, expanding work and roles, beginning to recognize one’s mortality - fifties involve: sandwich generation - middle-aged adults, who are multigenerational caregivers dealing with the complex roles of wife, mother, daughter, caregiver, and employee, and chronic diseases later adulthood • - sixties involve: retirement, more leisure time, greater attention to physical activity and nutrition importance of nutrition • ages 20-64 is a time when diet, physical activity, smoking, and body weight strongly influence the future course of health and wellness • lifestyle choices interact with genetic endowment, social forces, and environmental factors to determine years of life and quality of life • diet types that could increase risk of chronic diseases: - carcinogenic diet (cancer) - low fruit and vegetable intake, low level of antioxidants, low intake of whole grains and fibre, high dietary fat intake, nitrosamines (burnt food), high intakes of pickled or fermented food, alcohol consumption, high animal-food, low plant-food - atherogenic diet (heart disease, diabetes) - high saturated fat, trans-fatty acid intake, dietary cholesterol intake more than 300mg, low fruit and vegetable 1 Thursday, February 2, 2017 intake, low antioxidants, low intake of whole grains, no or excess alcohol intake, high sodium intake, low potassium intake, low intake of milk and diary, high waist circumference - obesogenic diet (obesity, diabetes) - too much calories, unstructured eating, frequent fast-food, high fat intake, sugar-sweetened beverage consumption, energy-dense, low-nutrient food Tracking Adult Nutritional Health And Its Determinants nutrition status and factors that promote or interfere with achieving optimum nutrition status of the adult population are tracked using standard indicators monitoring process starts with assessing food intake, nutrient adequacy, and weight status at the individual level, and then summarized across population groups social determinants of health - socioeconomic and environmental factors that are powerful determinants of health and are largely outside of the control of individuals and groups healthy objectives for the nation • Healthy People 2020 - social determinants of health: economic stability, education, health and health care, neighbourhood and built environment, social and community context health disparities among groups of adults • non-Hispanic Black women have the highest obesity rates, followed by Mexican • association exists between family income and obesity in White females of all ages • numbers of cases for cancer in American Indian women have increased • Black and Hispanics are 77% and 66% more likely to get diabetes than Whites • American Indians have a genetic predisposition for diabetes • Asians develop cardiovascular disease at lower BMI and smaller waist circumference • African-Americans have greater salt sensitivity and earlier onset of hypertension • health disparities - groups that have higher prevalence for certain conditions and experience worse health but also tend to have social and economic disadvantages 2 Thursday, February 2, 2017 Physiological Changes During The Adult Years individuals tend to stop growing by their twenties, but continue to develop bone density until their thirties muscular strength peaks around 25-30 years but dexterity and flexibility begin to decline type and amount of physical activity has significant impact on body composition, including lean body mass (sum of fat-free body tissue: muscle, bone, and water), fat accumulation and relocation, and bone density hearing loss begins at 25 or earlier, and vision changes by age 40 hormonal and climacteric changes • climacteric changes - changes associated with the end of reproduction (menopause and reduction of testosterone) • perimenopause - decline of estrogen production for women (begins at age 50) - menopause - end of reproductive capacity; associated with increased abdominal fat and risk of cardiovascular disease - women with a greater body mass tend to have a later menopause • estrogen is involved in the portion of calcium to bones, health of blood vessel walls, blood cholesterol and triglyceride levels, and elasticity of the skin - high levels of estrogen are associated with obesity due to production of estrogen by fat cells body composition changes in adults • bone - bone shape is modified in and response to physiological influences and mechanical forces - around age 40, begin to gradually lose bone mass, and risk of osteoporosis and osteopenia depends of peak bone mass achieved in twenties • adiposity 3 Thursday, February 2, 2017 - positive energy balance (equilibrium state where number of calories consumed equals number of calories expended) typical between 20-64 results in weight gain and storage of excess energy in adipose tissues - storage begins with hypertrophy of subcutaneous fat cells, then shifts to deposits in the central and intra-abdominal space and other tissues such as, heart, blood vessels, liver, and muscle - risk of diseases increase as weight and adiposity increase • gut microbiome - complex microbial community in the gut shifts and adapts with age, diet, geographical location, stress, supplements, and medications, but each individual has a gut microbiota “fingerprint” that is relatively stable - healthy gut microbiota activates and supports the immune system, protects against opportunistic pathogens, digests food to release nutrients and energy from diet, ferment non digestible carbohydrates, synthesize vitamins, stimulate renewal of cells of intestinal lining, control colonic motility and transit time, and provide regulatory signals through the gut-brain axis - gut dysbiosis - breakdown in the balance of protective and harmful bacteria in the intestines continuum of nutritional health • good genes, good habits, good environment, and good luck, can make aging minimal and nutrition and physical health can be maintained throughout adulthood stages of continuum of nutritional health: • resilient and “healthy” - metabolic stems are in homeostasis, and organs are functioning at optimum level - body’s defences and immune system can counter assaults from toxins, pathogens, and stress - nutritional guidance and education are used to encourage adequate intake of healthy foods • altered substrate availability - intake does not meet needs, either too little or too much 4 Thursday, February 2, 2017 - nutrients are drawn out of other body compartments - may be a buildup of byproducts resulting from inefficient or altered metabolism - when substrates are not available in appropriate amounts, adaptive mechanisms kick in, but they reach limits - nutrition education and dietary guidance attempts to inform people about common risks and encourages healthy diets to revers subclinical changes • nonspecific signs and symptoms - insufficient or excessive intake leads to observable changes that could lead to chronic diseases - immune function is affected and there is a reduced resistance to pathogens, chemical exposures, radiation, and stress - screening is used - dietary guidance, nutrition counselling, and medical nutrition therapy are potential interventions • clinical condition - if changes are not made and nutritional injury persists, symptoms of illness are now present, and medical diagnosis is made - intensive intervention such as medical nutrition therapy or therapeutic behaviour change programs may be necessary to manage disease and prevent development • chronic condition - altered metabolism and structural changes in tissues become permanent and irreversible - intervention is aimed at managing condition, preventing forth complications, reducing degree of disability, and optimizing quality of life • terminal illness and death - complications advance, body systems shut down, and life ceases 5 Thursday, February 2, 2017 Energy Recommendations energy requirements - the amount of dietary energy intake needed to be consumed by individuals to sustain stable body weight consistent with long-term good health that would allow for adequate levels of physical activity to maintain social, cultural, and economic activity healthy weight for most individuals is a BMI of 18.5 up to 25 Kg/m2 age-related changes in energy expenditure • metabolic rate and energy expenditure begin to decline in early adulthood at a rate of 2.9% for men and 2.0% for women per decade - corresponds with decline in physical activity and lean body mass • ages 25-65, physical working capacity decline by 5-10% per decade - presence of musculoskeletal disease, obesity, and other conditions can accelerate decline • calorie intake for men decrease 22%, from 2700 to 2100 calories, between 30-80 - behavioural, social, and environmental factors supersede the innate physiological ability to adjust caloric intake with energy expenditure estimating energy needs in adults • energy needs are based on individual’s: - basal metabolic rate (BMR) - amount of energy required for cellular metabolic processes and function of organs (60% of energy needs) - thermic effect of food (TEF) - energy required for digestion, absorption, and metabolism of food (10% of energy needs) - activity thermogenesis - energy expended through physical activity and non exercise activity such as fidgeting (20-40% of energy needs) • largest component of daily expenditure, 60-70% for most adults, is the involuntary process of internal chemical activities that maintain the body • estimated energy requirements (EER) - average dietary energy intake for adults in good health, by age, gender, weight, height, and level of physical activity, that is predicted to maintain energy balance and is consistent with good health 6 Thursday, February 2, 2017 - doubly labelled water technique (DLW) - a precise method of measuring energy utilization in real living conditions, by drinking water containing isotopes of hydrogen and oxygen, and when discreet in saliva and urine, calculate energy utilization • resting energy expenditure (REE) - measured or estimated energy expenditure in an individual at rest - indirect calorimetry is done by measuring the exchange of gases during respiration, for a specific period of time (usually 24 hours) - Mifflin-St. Jeer Energy Estimation Formula - males: REE = (10 x 3 wt) + (6.25 x ht) - (5 x age) + 5; females: REE = (10 x wt) + (6.25 x ht) - (5 x age) - 161; height in cm and weight in kg - after REE is determined , value is multiplied by activity factor (1.2 sedentary, 1.55 moderately active, or 1.725 very active) to get the daily caloric expenditure - for athletes, formula based on lean body mass is recommended, which produces a higher and more accurate EER reflecting the effect of greater lean muscle mass on BMR - approximately, 15 calories per body pound is needed to maintain weight, 13 to lose weight, and 17 to gain weight energy adjustments for weight change • a pound of body weight equal 3500 calories, and to lose 1 pound a week, one would have to eat 500 calories less daily (decrease calorie intake and increase physical activity) energy balance • adults need to pay attention to the balance between energy in and out • reduction of total energy intake enhances weight loss regardless of the macro composition of the diet - regardless if diet is low fat, high protein, low carb, or balanced, the point is to consume fewer calories and incorporate more physical activity Nutriton Recommendations macro and micro nutrient recommendations 7 Thursday, February 2, 2017 • acceptable macronutrient ranges for adults include: - fat: 25-35% of calories - carbohydrate: 45-65% of calories - protein: 10-35% of calories risk nutrients • fiber - dietary fiber decrease energy density of diet and high-fiber diet is linked with lower body weight and less weight gain overtime - slows gastric emptying time and produces longer sensation of fullness - vicious fiber - types of fiber characterized by their ability to form a gel solution when combined with liquid (soluble fiber); decreases absorption of cholesterol, increases fecal excretion of cholesterol-rich bile, and results in lower blood levels of total and LDL cholesterol; ex. oatmeal - fermentable fiber - type of fiber that enters the large colon undigested, where it is acted on by the bacteria of the gut (insoluble fiber); ex. skin of fruit and wheat or corn bran - functional fiber - isolated or purified undigestible carbohydrates that have beneficial physiological effects in humans; ex. resistant starch • calcium and vitamin D - low vitamin D int
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