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Chapter 19

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University of Guelph
NUTR 2050
Simone Holligan

NUTR 2050 Chapter 19 (p.489-492, 497-500, 506-513) Consumption of fish, fish oils, and omega-3 polyunsaturated fatty acids is of special interest to older adults because so many have underlying heart disease. - Individuals with coronary heart disease and heart failure should commit to consuming 800- 100mg/day or more of EPA and DHA (which are essential fatty acids—Omega 3) Stroke Definition - serious condition involving reduced cerebral blood flow (brain ischemia) - TIAs (transient ischemic attack) are brief episodes of neurological dysfunction such as sudden confusion, trouble speaking or understanding, or sudden dizziness and trouble walking, often come before a stroke Two Types of Strokes Ischemic stroke (about 85% of all strokes) - An obstruction clogs a blood vessel and prevents oxygen and other nutrients from reaching part of the brain. Hemorrhagic stroke - A weakened blood vessel breaks, such as the rupture of an aneurysm. Leaking blood accumulates, putting pressure on the surrounding tissue and eventually destroying brain cells. Prevalence - Of adults aged 65 and older, 8% of females and 10% of males have had a stroke. - Six months after having a stroke, 34% of women and 16% of men were disabled. - Age adjusted first-ever strokes in 45–84-year-olds occur more often in black males and females (6.6 and 4.9 per 1000 population) than white males and females (3.6 and 2.3 per 1000 population). Effects of Stroke - Leads to loss of function for parts of the body controlled by the oxygen-deprived cells (usually one half of the body) - Although dead brain cells cannot be replaced, new nerve pathways can develop in the gray- matter reservoirs of the brain. - The ability to develop new neural pathways provides hope for successful rehabilitation therapies. Risk Factors - Long-term high blood pressure (either systolic or diastolic) - Family history of strokes - African American, Asian, and Hispanic ethnicity - Physical inactivity - Cigarette smoking (doubles the risk of ischemic strokes!) - Comorbid conditions, including diabetes mellitus, carotid artery disease, atrial fibrillation, transient ischemic attacks (TIAs), sickle cell anemia, and depression - Living in poverty - Excessive use of alcohol; use of cocaine and illicit intravenous drugs o Moderate amounts of any type of alcohol can be protective against stroke, while excessive amounts increase stroke risk significantly Nutritional Remedies - Normalize blood pressure Hypertension Definition - High blood pressure (HBP) is defined as “untreated systolic pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher or taking antihypertensive medicines.” - Pre-hypertension increases risk for CVD and is defined by systolic pressure of 120–139 mm Hg or diastolic pressure of 80–89 mm Hg Prevalence - Hypertension (HBP) is the only chronic condition that has higher prevalence in older adults than arthritis - Before age 45, a higher proportion of men than women have HBP; then the percentages are similar until age 64, when HBP becomes more common in women. - Death rates from high blood pressure are much higher for blacks than for whites - 70% who have it are aware they have it, yet only 34% of individuals with hypertension have it under control. Etiology - Family history and ethnic background increase the risk of hypertension; - Salt intake can also contribute to hypertension, although not every individual is salt sensitive. Effects of Hypertension - Wears out the organs in the body before the natural aging process - Damaged kidneys come from prolonged untreated hypertension Risk Factors - Nutritional risk factors are drinking alcohol to excess, high-saturated-fat diets, lifestyles resulting in overweight and obesity, and a diet low in calcium Nutritional Remedies - Weight management, moderation of alcohol intake for those who drink, and limiting sodium intake while maintaining adequate potassium, magnesium, and calcium intakes. - DASH diet is effective in decreasing blood pressure24 and risk of stroke in adults under age 65. o It has been shown to enhance perceptions of quality of life. - Choosing foods with less processing can help to limit sodium intake, because approximately 75% of dietary sodium is attributable to manufacturing and preservation processes, with salt at the table contributing the rest. Osteoporosis - Osteoporosis is four times more common in women than men (80% compared to 20%), in part due to greater peak and total bone mass in men. - Prevalence rates for osteoporosis are elusive because osteoporosis has no symptoms, such as feeling one’s bones becoming weaker - The chance that an adult over age 50 will have an osteoporosis-related fracture during the remainder of his or her life span is approximately 1 in 2 for women and 1 in 4–5 for men Etiology - Inadequate building of peak bone mass coupled with significant bone loss leads to a low bone density and increased risk for fractures. Inadequate Bone Mass - Development of osteoporosis is delayed when an individual develops bigger, denser bones during Youth - Studies in the United States have also shown that getting enough calcium during growth spurts (between ages 11 and 17) reduces the risk of osteoporosis. - Inactivity such as that due to bed rest and sedentary lifestyle leads to bone loss. - Weight-bearing or resistance exercises are needed to develop bone mass because bone grows in response to pressure on the bone tissue. - “Use it or lose it” Increased Bone Loss - When calcium levels in the blood fall, the body responds by secreting moreparathyroid hormone (PTH). o PTH acts to raise blood calcium levels by increasing dietary calcium absorption, decreasing urinary excretion, and by releasing calcium from bone. o Excess blood calcium stimulates calcitonin secretion. o The hormone calcitonin slows release of stored calcium. o Bone mineral reserves are dissolved (resorption) and rebuilt continuously, thus maintaining adequate calcium levels for crucial messenger functions. - When a portion of this build-dissolve-rebuild cycle is malfunctioning, the body’s first priority is to maintain blood calcium levels for nerve, muscle, and enzyme functions. - Osteoporosis can develop from a shortage of phosphoros during bone mineralization. - Finally, the process of normal aging results in a slow increase of PTH as well as a decrease in the skin’s ability to make vitamin D; both lead to bone loss. Effects of Osteoporosis Falls and Fractures - Fractures and the resulting injuries may make it impossible for an older adult to remain independent, but not everyone who falls sustains injury. - Ten to 20% of older persons who break a hip die within a year. o Death is not due to the fracture itself but to complications resulting from the break.  One of these complications is impaired mobility, complicating all the activities of daily living (including eating and exercising). Shrinking Height, Kyphosis - Postmenopausal women with compression and/or a bone fracture in the spinal column have a condition known as “shrinking height,” leading to dowager’s hump (also known as kyphosis, meaning a bent upper spine). - Shrinking in height is slow and usually not painful. Risk Factors - A typical osteoporosis patient is a petite elderly white female. Nutritional Remedies Calcium - On average, older Americans are consuming 300 to 450 mg less calcium than the DRI, which is 1200 mg per day, and still less than the 1500 mg calcium recommended by the Canadian osteoporosis management guidelines Balancing Nutrients for Bone Health - Depending on level of intake, some nutrients interfere with calcium metabolism - High protein levels lead to greater calcium excretion, although losses are small - several nutritional habits can improve calcium intake and absorption: o Consume calcium-rich beverages like milk and kefir or yogurt drinks with a meal: food slows intestinal transit time and allows more calcium to be absorbed from the gut; protein from dairy products becomes substrate for new bone matrix. o Increase fruit and vegetable intake for their alkalinizing effect; the alkaline environment improves calcium balance by inhibiting bone resorption. o Consume foods that are rich in bone-building vitamins and minerals at recommended levels. This balance will promote bone synthesis of the collagen matrix, into which minerals are deposited during bone mineralization. o Vitamin D stimulates active calcium transport in the small intestine and colon; for residents of locales with seasonally ineffective sun exposure, supplemental vitamin D can maintain blood levels to suppress PTH levels and increase calcium absorption. o Greens are especially rich sources of the vitamin K needed for formation of proteins that stimulate osteoblasts and osteoclasts, active in bone remodeling. o High sodium intake leads to higher levels of urinary calcium; that is, more calcium is excreted when higher levels of sodium are eaten. o Caffeine to equal 2 to 3 cups of coffee daily (in postmenopausal women), consumed in conjunction with a low calcium intake, has been associated with bone loss. o If taking supplements, divide dosage throughout the day for greater absorption. Carbonate is better absorbed with food, while citrate is well absorbed with or without food. Take calcium at a different time than antacids, because stomach acidity enhances absorption. In cases where stomach acidity is decreased, calcium citrate is more soluble than calcium carbonate. Exercise - Canadian practice guidelines for non-pharmacologic interventions in osteoporosis recommend physical activity ≥30 minutes per day three times per week Other Issues impacting Nutritional Remedies Vitamin K CAUTION - Vitamin K plays an important role in the blood clotting process. o When older adults with a history of strokes are placed on an anticoagulant like warfarin, nutrition counselors can advise them on how to maintain a stable vitamin K intake. - Two forms of vitamin K are found in foods. o Phylloquinone, also known as vitamin K1, is naturally occurring in plants, and menatetrenone, vitamin K2, is found in meat, cheese, and fermented products. Hormones - Hormones direct the dynamic system of bone remodeling. - Estrogen, testosterone, growth hormone, and insulin-like growth factor-1 (IGF-1) increase intestinal calcium absorption. - Hormone replacement, with or without additional calcium, can effectively increase bone mineral density in postmenopausal women. Medications - Serotonin reuptake inhibitors (SSRIs) such as Prozac are frequently prescribed for depression; they are associated with bone loss. - Serotonin produced in the duodenum suppressed osteoblast proliferation. ORAL HEALTH - At the turn of the century, about one-third of all adults had no natural teeth; now that number has dropped to about one-fourth of older adults who have no natural teeth - Changes in oral health are most likely to be a result of disease, medical treatment, or medications rather than aging itself. - Periodontal disease (PD) and xerostomia (known as dry mouth) are two conditions that can interfere with food tolerance and with enjoyment of food. o PD results from bacterial infections of the gingiva, with destruction of the ligaments attaching teeth to the jawbone, and with receding gums. o Plaque builds up in the resultant pockets, contributing to further infection and eventual tooth loss. o Persons whose overall health and immune system are compromised are at greater risk for periodontal disease. o Prevention of PD emphasizes strict oral hygiene to remove plaque, enhancing immune status, and ensuring optimal nutrition. o Correcting potential deficiencies of calcium, vitamin D, and magnesium will help postmenopausal women keep their bones, including the jaw, strong. o High blood sugar raises glucose in saliva, leading to caries and accelerated periodontal disease. It can also make the mouth more susceptible to yeast infection (candidiasis) o Medications and other treatments are the likely causes of dry mouth o Head and neck cancer treatment can also lead to xerostomia when the salivary glands are involved. o Lack of saliva for any reason gives bacteria a better environment to build plaque. Other oral problems are loss of taste (dysgeusia) and pain of the tongue (glossodynia) - Tea sippers (black tea, no sugar) may even have an advantage here; the polyphenols in black tea seem to interfere with the bacteria’s ability to stick to the plaque. CASE STUDY 19.1—Bridget Doyle Remembers Laura Just because she lives at Lenoir Manor, a continuing-care retirement facility, Laura, a petite (4 ft. 8 in., 97 pounds) widow of the local college dean, does not consider herself as old. She is 87. She has had no major nutritional or health problems and her appetite is good. She had been a good cook and entertained graciously, but in the residential care facil
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