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Chapter 18

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University of Guelph
NUTR 2050
Jess Haines

NUTR 2050 - Chapter 18 FOOD MATTERS: Nutrition Contributes to a Long and Healthy Life • A positive outlook to one’s own old age is associated with increased longevity o i.e. older individuals with more positive self=perceptions lived 7.5 years longer than those with less positive self-perceptions of aging • Older adults feel thatgood nutrition and exercise are the most important health habits they can maintain to avoid losing autonomy and independence • Leading causes of death for people aged 60 and older are - heart disease cancer, stroke and diabetes • O lder adults can meet their decreasing energy requirements by: o choosing more nutrient-dense foods o drink more water to stay hydrated even when not thirsty o adequate amounts of ve ggies, fruits and whole grains o keeping fats in balance o drink alcohol in moderation (reduce risk of disease) • Good health habits help to delay mortality and achieve compression of morbidity in older populations; Compression of morbidity= shortening the period of illness and decreased functional capabilities at the end of life. • There is NO biological benchmark which signals a person’s becoming old; the arbitrarily set retirement age of 65 years to denote an older adult is used in this work • Functional status = description of how well one can accomplish the tasks of daily living, and is more indicative of health than chronological age • Longevity = length of life, measured in years • In assessing contribution of good nutrition to longer liCenters for Disease Control and Prevention (CDC) suggests longevity depends: o 19% on genetics o 10% on access to high quality healthcare o 51% on lifestyle factors • Besides smoking, diet and exercise are estimated to be the lifestyle factors contributing most to decreased mortality or longer life • Besides reducing risk of disease and delaying death, diet contributes to wellness Wellness = having the energy and ability to do the things one wants to do and to feel in control of one’s life • Good nutrition can “add life to years” as well as “adyears to life” PICTURE OF THE AGING POPULATION 2 • By 2050 – 20% of population expected to be over 65, 5% over 85 and 1% of the population is expected to be a centenarian = person who reaches age 100 or more; persons aged 85 and older are the fastest growing segment of the population • since early 1990s, immunizations and other risk reduction measures, treatment of disease, decreased infant and childhood mortality rates and clean water and safe food have increased average life expectancies which are getting closer to potential human life span • Life expectancy = average number of years of life remaining for persons in a population cohort or group; most commonly reported as life expectancy from birth o Life expectancy in the USA is 78 yrs now compared to 47 years for someone born in 1900 • Life span = maximum number of years someone might live; human life span is projected to range from 110 to 120 years • Although life expectancy is rising, life span remains stable at around 110 – 120 years. THEORIES OF AGING Theories of Aging can be examined from 2 perspectives: 1. Programmed Aging a. Hayflick's Theory of Limited Cell Replication o P roposed that all cells contain a genetic code that directs them to divide a certain number of times during a life span o A fter cells divide according to their programmed limit and barring disease or accident the cells begin to die (senescence) o Hard to prove this theory in humans since we die from age-associated chronic disease more often that from old age itself b. Molecular Clock Theory o Telomeres = a cap-like structure that protects the end of chromosomes; it erodes during replication o eventually loss of telomeres stops the ability of chromosomes to replicate and produces signs of aging because new cells cannot be formed and functions of existing cells decline 2. 2. “Wear and Tear” Theories o Built on the concept that things wear out with use. o Accumulation of damaged cells and waste by-products leads to declining function and aging a. Free-Radical or Oxidative Stress Theory o O xygen is a integral and versatile part of metabolic processes and can both accept and donate electrons during chemical reactions o O ne cause of aging is thought to be oxidative stress due to the buildup of reactive (unstable) oxygen compounds which break down cell membranes and damage cells needed to keep the immune system intact o this can be increased by smoking, ozone, solar radiation and environmental pollutant s o Antioxidants can neutralize these compounds and can be met through diet (e.g. Selenium, Vitamin E and C and phytochemicals such as beta-carotene, lycopene, flavonoids, lutein), zeaxanthin, resveratrol and isoflavones b. Rate-of-Living Theory 3 o faster living results in faster aging o scientists have not adequately examined old people including centenarians to fully understand this theory Calories restriction: decreasing energy level of one's diet by 25 to 30% while meeting protein, vitamin and mineral needs PHYSIOLOGICAL CHANGES Body-Composition Changes • There is a decline in body mass of 2% to 3% per decade from 30 to 70, including loss of muscle (sarcopenia), beginning around age 40, even when weight is stable. • During this time fat increases, especially in the visceral region e.g. a 70 yr old male has 24 pounds less muscle and 22 pou nds more fat than a 20 year old • After age 70, weight, including fat, begins to decline due to lower levels of physical activity, food intake and hormonal changes • Resilience = ability to bounce back to deal with stress and recover from injury or illnes • Physical activity contributes to staying strong no matter what age; Weight-bearing and resistance exercise increase lean muscle mass and bone density • Functional status = ability to carry out the activities of daily living, including telephoning, grocery shopping , food preparation, and eating • Weight and BMI peak between 50 and 59 years then stabilize and start slowly dropping around age 70 Awareness -Taste and smell o Taste & smell sense are robust until age 60 when they start to decline o 60% of individuals over the age of 80 have some olfactory impairment, compared to 6% of adults in their 50s o Women retain their sense of smell better than men o Declining taste and smell result in decreased ability to detect spoiled or burnt foods Oral Health: Chewing and Swallowing o P oor dietary habits can contribute to potential tooth loss - associated with disability and mortality in old age o Tooth loss high in Native American elders (42 %)—due to education and income Appetite and Thirst o H unger and satiety cues (i.e. feeling full or satisfied) are weaker in older adults o E lderly people don't seem to notice thirst as clearly as younger people do NUTRITIONAL RISK FACTORS • In adults of all agesdietary risk factors that increase likelihood of developing heart disease, cancer and stroke are consuming a diet high in 4 saturated fat and low intake of vegetables, fruits and whole-grain products • The DETERMINE Warning signs of poor nutritional health in older adults: o D isease – any disease puts you at nutritional health risk; o E ating poorly – too much, too little or not right type o T ooth Loss/mouth pain o E conomic Hardship – not enough $ for groceries o R educed Social contact o M ultiple Medicines – increased chances of side effects such as decreased appetitie o Involuntary weight Loss or gain – warning sign o N eeds assistance in self-care o E lder years above 80 – increases risk of frailty and health problems • Poverty is one risk factor for malnutrition; polypharmacy is another. (Polypharmacy = use of multiple drugs) • The purpose of the DETERMINE Screening Tool is primary prevention, as it identifies conditions that need further exploration. In secondary prevention (e.g. testing for blood cholesterol or bone density), early symptoms of disease are prevented and treated to prevent worsening of the condition Dietary Recommendations: Pyramids for Older Adults • Recommendations for specific nutrients change with age, and food consumption patterns need to adjust accordingly (e.g. older adults have a greater need for nutrient density and active fluids, and declining need for calories) Nutrient Recommendations • Nutrient recommendations change as scientists learn more about the effects of food on human functions Estimating Energy Needs • The main goal for energy calculation is to maintain healthy body weight • Over a decade, daily energy needs decline by 70-100 calories Nutrient recommendations for Older Adults • Carbohydrate and Fibre (e.g. grains, fruits, vegetables) - 45-65% of calories  21 and 30 grams of fibre depending on the caloric intake for both sexes aged 51+ (14g/1000 cals)  F emales eat 14g and males eat 17g which is less than the recommended levels  D ietary fibre reduces the risk of coro
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