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Chapter 16

Chapter 16 Adult Nutrition.docx

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Department
Nutrition
Course
NUTR 2050
Professor
Jess Haines
Semester
Winter

Description
Week 3 January 21-27 , 2013 Chapter 16: Adult Nutrition Introduction -Adulthood is subdivided into the following segments: -Early Adulthood  20’s generally involve becoming independent, leaving the parental home, finishing formal schooling, entering regular employment and starting a career, developing relationships, and choosing a partner  Planning, buying, and preparing food are newly developing skills for many  30’s involves increasing responsibilities to and for others, including having children, providing for and caring for family, building a career, and involvement in community and civic affairs and there may be a “renewed” interest in nutrition at this time for the kids’ sake -Midlife  40’s are a period of active family responsibilities (nurturing children, and teenagers, building new relationships and blending families potentially), as well as expanding work and professional roles  Managing schedules and meals becomes a challenge  50’s is around the time of the “sandwich generation” where mainly women are multigenerational caregivers who juggle the roles of caring for children and aging parents while maintaining a career  Health concerns frequently are added to the picture  Dealing with a chronic disease or managing identified risk factors to prevent diseases is an added responsibility -Old Age  60’s, adults are making the transition to retirement, have more leisure time, are able to give greater attention to physical activity and nutrition  Many are “empty-nesters” but a significant amount of people at this age have children living at home and/or have responsibilities as guardians and caretakers of grandchildren, parents, or others  Food choices and lifestyle factors may take on an added significance for those who are dealing with a chronic disease Importance of Nutrition  Between ages 20-64, diet, physical activity, smoking and body weight all strongly influence the future course of health and wellness  Lifestyle choices during these years interact with genetic endowment, social forces, and environmental factors to determine years of life and quality of life  The onset and severity of five of the ten leading causes of death in adults (cancer, heart disease, stroke, diabetes, and hypertension) have risk factors that can be modified through changes in nutrition and physical activity Health Objectives for the Nation  In the last decade, rates of heart disease, cancer and stroke have declined, whereas rates of obesity and diabetes have increased, sugar intake has risen, and health care disparities still exist  A priority of national public health goals is obesity Physiological Changes During Adulthood  For the most part, individuals have stopped growing by the time they reach their 20’s, but continue to develop bone density until the age of 30  The type and amount of physical activity has a significant impact on body composition, including lean body mass (musculature), fat accumulation and relocation, and bone density  By middle adulthood, physical changes become more apparent with the decline in size and mass of muscles and an increase in body fat  Dexterity and flexibility decline, as well as sensory and perceptual abilities  Hearing loss begins as early as 25, and vision changes often become noticeable by 40 -Hormonal and Climacteric Changes  The decline of estrogen production in women leads to menopause, the end of menstruation  Menopause is associated with an increase in abdominal fat and significant increase in risk of cardiovascular disease and accelerated loss of bone mass  Men experience a gradual decline in testosterone level and muscle mass  Obesity is associated with higher estrogen levels in men and women Body Composition Changes in Adults  Between ages 20-64, a positive energy balance occurs with an increase in weight and adiposity and a decrease in muscle mass  Redistribution of fat occurs –gains in the central and intra-abdominal space and away from subcutaneous fat –and is associated with increased risk for hypertension, insulin resistance, diabetes, stroke, gallbladder disease, and coronary artery disease Estimating Energy Needs in Adults  Energy needs are based on an individual’s basic metabolic rate (BMR), the thermic effect of food (TEF), and activity thermogenesis (which includes energy expended through exercise and non-exercise activity such as fidgeting)  The largest component of daily energy expenditure, 60-75% for most adults, is the involuntary process of internal chemical activities that maintain the body  The brain, liver, gastrointestinal tract, heart, and kidney make up less than 5% of body weight, but the active and metabolic processes and functions of these organs account for about 60% of BMR  The thermic effect of food amounts to 10% of energy needs but varies with diet composition and across individuals  TEF is lower in some obese individuals, suggesting that more efficient digestion and absorption of food may be a factor in obesity  Activity thermogenesis accounts for 20-40% of total energy expenditure  Calorimetry is the measurement of the amount of heat given off or absorbed by a reaction or group of reactions  Indirect calorimetry is used to determine resting energy expenditure (REE), a measure closely related to basal metabolic rate  It is done by measuring the exchange of gases during respiration, for a specific period of time, using a metabolic cart in hospitals or newer portable technology and hand-held devices in clinics and gyms  REE can also be calculated using a validated estimation formula –the Mifflin-St.Jeor formula -it was developed for healthy, normal-weight and moderately overweight men and women Males: REE = (10 X weight) + (6.25 X height) - (5 X age) + 5 Females: REE = (10 X weight) + (6.25 X height) - (5 X age) – 161 -after the REE has been determined, the value is multiplied by an activity factor (1.2 sedentary, 1.55 moderately active, or 1.725 very active) to arrive at the estimate daily calorie expenditure Energy Adjustments for Weight Change  A pound of body weight is the equivalent of approximately 3500 calories  To lose 1lb a week, an adult would need to create a negative caloric balance of 500 calories daily  These 500 calories can be generated from a combination of decreased calorie intake and increased physical activity  E.g. seven days of burning 300 extra calories and eating 200 fewer calories leads to a weight loss of 1lb  On the other hand, a positive balance of just 100 extra calories per day will result in a gain of 10lbs in a year Age-Related Changes in Energy Expenditure  Metabolic rate and energy expenditure begin to decline in early adulthood at a rate of about 2% per decade  These reductions generally correspond to declines in physical activity and lean muscle mass  Between 25-65, physical working capacity declines 5% to 10% per decade  In young, healthy adults, there is a compensatory adjustment between physical activity and calorie intake  Adult caloric intake declines with age  Increased calorie intake is related to the obesity epidemic Fad Diets  Dieting is so pervasive and weight loss is so difficult to maintain, that weight-loss efforts supports a multimillion-dollar industry  Estimated that 71% of females and 42% of males are dieting at any time  Weight cycling with weight remains larger than weight losses, also called yo-yo dieting, is considered more harmful than persistent overweight  Weight cycling is associated with higher cardiovascular and all-cause mortality  Diets are popularized and promoted by TV personalities, via web advertisements and print and social media  Popular approached to weight loss are commonly referred to as fad diets  Most should be viewed with caution, but some popular diets, such as the Mediterranean diet, are actually very healthful  Fad diets generally promise quick results –something easy and “guaranteed to get you into those tight new jeans”  They focus on fast weight loss promoted with testimonials, alluring before-and-after pictures, and deceptive marketing tactics  The following features flag unhealthy and potentially harmful fad-diet strategies: o Inadequate nutrient supply (restrictions deplete tissue reserves of important nutrients) o Severe energy restriction (diets with 800 or fewer calories a day require medical supervision) o Unusual food restriction (e.g. no carbohydrates) o Food combinations (e.g. grapefruit with all meals) o Strict limitations (avoiding certain food groups, such as no dairy or never eating potatoes) o Gimmicks (don’t eat after 7p.m., eat only popcorn for lunch)  Fad diets offer strategies to initiate weight loss, but most fail to offer realistic or healthful strategies to maintain weight loss, which is the real test of any weight-loss diet  Successful weight management comes from long-term lifestyle change  In weight loss, the aim is to lose fat while consuming a variety of low-calorie, nutrient-dense foods to meet nutritional needs and maintain body stores of nutrients –also includes physical activity to enhance the energy deficit and to shape and firm the body Continuum of Nutritional Health  With good genes, good habits, good environment, and good luck, nutritional and physical health can be maintained through adulthood  The interaction of those factors over the years, more likely results in “nutritional injury” which leads to alteration or loss of function at the cellular level –it may be minor, of short duration, and reversible, or if it continues, permanent changes in cells and tissues can develop  Several principles are emphasized for nutrition during the adult years: o Health problems related to nutrition originate within cells o Poor nutrition can result from both inadequate and excessive levels of nutrient intake o Humans have adaptive mechanisms for managing fluctuation in food intake o Malnutrition can result from poor diets and from disease states, genetic factors, or combinations of these causes o Poor nutrition can influence the development of certain chronic diseases o Adequacy and balance are key characteristics of healthy diets o There are no “good” or “bad” foods  Alterations progress over a long period, and are reversible up to a point  In the absence of signs and symptoms and awareness of a “problem,” adults might not be especially concerned about food choices or motivated to adjust lifestyle behaviours States of Nutritional Health -The continuum of nutritional health can be represented in 6 states or stages: 1. Resilient and “Healthy”  Metabolic systems are in homeostasis, and organs are functioning at optimum level  The body’s defenses and immune system can counter assaults from toxins, pathogens, and stress  Nutritional guidance and education are used to encourage adequate intake –not too much, not too little –of a variety of healthful foods  “Moderation, variety and balance”  Guidance is used to enable healthy individuals to anticipate and plan for possible risks so they can make informed choices to sustain resilience and prevent nutritional injury 2. Altered Substrate Availability  Occurs when intake does not meet needs  Loss of reserves and/or accumulation of excesses  Nutrients are drawn out of other body compartments, such as protein out of muscle or lung tissue and calcium for bones  May be a buildup of by-products resulting from inefficient or altered metabolism  When subtrates are not available in appropriate amounts, adaptive mechanisms kick in, but they reach limits  Nutrition education and dietary guidance directed at the public attempts to inform people about common risks and encourages healthful diets and lifestyle choices to minimize or reverse subclinical changes 3. Nonspecific Signs and Symptoms  Insufficient or excessive intake of nutrients or energy leads to observable changes (e.g. the accumulation of subcutaneous fat and central adiposity, elevated blood cholesterol, and insulin resistance)  By this stage, immune function is affected and there is reduced resistance to pathogens, chemical exposures, radiation, and stress  Screening should identify these changes and signal the need for intervention  Dietary guidance, nutrition counseling, and medical nutrition therapy are potential interventions to assist individuals in making changes at this stage 4. Clinical Condition  If changes aren’t made and the nutritional injury persists, frank signs and symptoms of illness are now present and a medical diagnosis is made (e.g. atherosclerosis, osteoporosis, cancer, type 2 diabetes, and depression)  A clear medical diagnosis is the turning point for serious lifestyle change for some adults  Change is difficult and intensive intervention such as medical nutrition therapy or therapeutic behaviour-change programs may be necessary to manage the disease and prevent or delay its progression and the development of side effects and complications 5. Chronic Condition  Altered metabolism and structural changes in tissues become permanent and irreversible (e.g. structural damage to coronary arteries, invasive and metastatic cancer, loss of kidney function, or blindness)  Major adjustments of life are necessary to self-manage the chronic disease and accommodate conditions that have significant impact on quality of life  Intervention is aimed at managing the condition, preventing further complications, reducing the degree of disability, and optimizing quality of life 6. Terminal Illness and Death  Complications advance, body systems shut down, and life ceases Health Disparities among Groups of Adults -Some population groups are more likely to experience “nutritional injury” and its consequences than are others -Comparisons of disease prevalence in adults of different racial/ethnic backgrounds:  High blood pressure is 30% higher in African Americans compared to whites, Hispanics, and Asians  Physician-diagnosed diabetes in Mexican-American females in 2006 was 14.2% compared to 6.1% in white females  Blacks > 18 years of age were more likely to be obese than American Indians or Alaska Natives, whites, and Asians  The proportion of obese adults who were told they were overweight by their health care provider was significantly lower for blacks and Mexican Americans than for whites -Some groups have a genetic predisposition for certain diseases -E.g. American Indians –diabetes; Asians – cardiovascular disease at lower BMI and smaller waist circumference; African Americans –greater salt
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