6. Nutrition

Question 1

Oral factors contributing to nutritional issues in elderly

Answer 1

• Ability to chew
• Taste and smell
• Xerostomia (drug induced)

Question 2

Physical factors contributing to nutritional issues in elderly

Answer 2

• Absorption
• Metabolism of nutrients
• Energy requirements and activities
• Medication affect on appetite and absorption

Question 3

Functional factors contributing to nutritional issues in elderly

Answer 3

• Changes in eyesight/hearing
• Disability such as arthritis/stroke
• Inability to shop/cary groceries

Question 4

Psychosocial factors contributing to nutritional issues in elderly

Answer 4

• Loneliness/isolation
• Loss of appetite/interest in eating
• Finances
• Depression

Question 5

Examples of different changes in absorption

Answer 5

• Atrophy of intestinal mucosa (seen in 25% of >60 y/o)
• Enzyme deficiencies –> decrease in intrinsic factor –> pernicious anemia
• Decreased lactase function
• Decreased fat absorption
• Changes in GI mobility –> constipation and laxative abuse

Question 6

BMR (basal metabolic rate) drops _% from 30-60 y.o

Answer 6

30

Question 7

Calorie and protein requirement increases under what conditions

Answer 7

-Stress associated with fever, trauma, surgery and disease

Question 8

What senses of taste acuity decline with age

Answer 8

-Bitter, salt and umami (not sweet and sour)

Question 9

Zinc deficiency can influence

Answer 9

taste acuity

Question 10

What is a functional unit

Answer 10

A chewing pair (opposing teeth)

Question 11

Do you need teeth to absorb nutrients

Answer 11

Most nutrients no- the only foods it did matter for where chicken breast, chicken leg and stewed lamb (Class II foods)

Question 12

What percent chewing efficiency is needed for complete absorption of class II foods

Answer 12

23%

Question 13

Do soft relines improve chewing efficency

Answer 13

yes

Question 14

Why do we need good function

Answer 14

• Choking
• Food choice
• Comfort
• Confidence

Question 15

T/F Number of chewing strokes increases as dentition deteriorates

Answer 15

F- number of chewing strokes is a hibit and doesn’t change

Question 16

Lack of dentition leads to an avoidance of what kinds of foods

Answer 16

• Crunchy in texture
• Fewer raw foods (carrots, apples, etc)
• Leafy foods

Question 17

Vitamin levels in denture wearers tend to be low for what reason

Answer 17

food choice

Question 18

Increased cholestrol can lead to what adverse health conditions

Answer 18

heart disease or stroke

Question 19

Decreased fiber can lead to what adverse health conditions

Answer 19

Colon cancer

Question 20

Decreased fruits and veggies can lead to what adverse health conditions

Answer 20

vitamin deficiency

Question 21

Significant association between weight (loss/gain) with edentulism

Answer 21

both

Question 22

The most validated functional measure of nutritional status is

Answer 22

fist-grip dynamometry (FGD) –> tests grip strength

Question 23

What is most widely used during lab test for FGD

Answer 23

serum protein levels

Question 24

Retinol binding protein increase suggests

Answer 24

renal failute

Question 25

Albumin level decrease indicates

Answer 25

liver failure

Question 26

Machine used to measure fat percentage

Answer 26

DEXA (Dual energy X-ray absorptiometry) or Harpenden calipers

Question 27

DEXA overestimates fat on (over/under) weight people and underestimates fat on (fat/lean) people

Answer 27

over... lean

Question 28

T/F People with more teeth live longer

Answer 28

t

Question 29

Impact of nutrition on oral disease

Answer 29

- Reduction in micronutrients critical for mucosal turnover manifest as oral mucosal disease - FE and B12, Folate-necessary for mucosal integrity - Atrophic tongue anemia or VitB deficiency - Oral ulcerations and red lesions higher in deficient pt. - Burning mouth - Angular chelitis

Question 30

Effect of alcohol on oral cavity

Answer 30

- Erosive atterns due to acidity of some drinks or frequent emesis - Increased dental caries due to high sugar in some drinks and neglect - Increased risk of oral carcinoma

Question 31

People with poor dentition consume a diet high in

Answer 31

refined carbs

Question 32

_ deficiency has been associated with premalignant lesiosn

Answer 32

Fe

Question 33

_ may mitigate perio disease

Answer 33

antioxidants

Question 34

Signs of nutritional deficiency in the mucosa and what nutrients

Answer 34

Chelitis (angular stomatitis) --> folic acid, iron, niacin, protein, riboflavin, and B12

Question 35

Signs of nutritional deficiency in the gingiva and what nutrients

Answer 35

- Predisposition to bacterial infection - Capillary wall defects *niacin, and VitC*

Question 36

Signs of nutritional deficiency in the tongue and what nutrients

Answer 36

- Reddening of tip and edges - Magenta color - Granular dorsum - Shiny tongue - Lingual burning **VitB complex, niacin, riboflavin, Fe, protein, B12**

Question 37

Disease associated with vitamin C deficiency

Answer 37

scurvy

Question 38

Psychosocial aspects of poor nutrition

Answer 38

- Avoid social contects that involve eating - Embarrased cutting food into small peices and struggling with chewing - Unfamiliar foods (meals on wheels) - Loss of spouse that prepared them food - Low income

Question 39

T/F improvement of oral function results in dietary improvment

Answer 39

f- but there is an improvement in perceived chewing ability BUT there is improvement if there is improvement of function AND concerted dietary intervention