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Nutrition > Diet and nutrition in adulthood and older age > Flashcards

Diet and nutrition in adulthood and older age Flashcards

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1
Q

Choice of food

A

Age/ gender/ state of health/ mood
Cost/ availability/ personal preferences
Socio-economic factors/ geographical location/ culture/ religion

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2
Q

Socio-economic factors

A

Advertising, income, environment, transport, social status

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3
Q

Dietary habits

A 
Long-standing preferences (adults)
Opinions
Effective advice for change
-practical 
-acceptable
-simple modification of existing habits
-adopting a completely new diet - unreasonable/ impractical
-knowledge, attitude, behaviour
-environment, access
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4
Q

Adult nutrient needs: energy requirements

A

usually decline at end of teenage years
Due to decrease in lean body tissue (muscle)
Give rise to fall in basal metabolic mate (BMR)
Less active

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5
Q

Adult nutrient needs: nutrients

A

Fat, fibre and carbohydrate same

Vitamins and minerals mainly unchanged (except Fe until menopause, vit A, vit D, K)

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6
Q

Adult nutrient needs: overall

A

Less energy but unchanged vitamin and mineral requirements etc.
-more nutrient dense foods

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7
Q

GDAs women

A 
2000 calories
230g carbs
50g of which sugars
70g Fat
20g saturated fat
45g protein
25g-30g fibre
6g salt
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8
Q

GDAs men

A 
2500 calories
300g carbs
70g of which sugars
95g fat
30g saturated fat
Protein 55g
25g-30g Fibre
Salt 6g
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9
Q

High/ low per 100g (GDAs)

A

15g/ 5g carbs
20g/ 3g fat
5g/1.5g saturated fat
4g/0.3g salt

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10
Q

Fat recommendations

A

Total intake ~35% dietary energy

Reduced fat spreads and low-fat dairy

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11
Q

Saturated fat recommendations

A

Total intake <11% dietary energy

Replace saturated fats and oils with those low in saturated, rich in polyunsaturates

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12
Q

Complex carbohydrates recommondations

A

Increase by 50%

Increase consumption of fruit, vegetables, bread, potatoes

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13
Q

RDAs alcohol

A

Men and women <14 units per week; spread out
Unit: 1/2 pint, spirit measure; glass wine ~2 units
Abdo weight, stroke, high blood pressure, cancer, liver disease, mental health; smoking
None in pregnancy (CMO, 2016)

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14
Q

RDAs Salt

A

6g (2.4g sodium)

75% in ‘bought’ food (processed)

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15
Q

Essential cholesterol

A

Structure and function of cell membranes

Precursor to steroid and adrenocortical hormones; bile acids and neural tissue

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16
Q

Source of cholesterol

A

1/3-1/2 made in liver, rest from diet (smoking, weight, activity)

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17
Q

HDL, LDL

A

If total increases due to HDL, little risk of CHD; LDL levels NB
Oxidise, form atheromas, narrowing
Dietary saturated fat raises LDL, polyunsats lower LDL and HDL
LDL cholesterol 2.3-6.1 mmol/l (suggested range <4mmol/l)
HDL cholesterol 0.8-1.7mmol/l, >1.15mmol/l

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18
Q

Total cholesterol

A

3.5-7.8 mmol/l

Suggested range <5.2mmol/l

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19
Q

Practical hints for diet

A

Eat more starch/ carbs - larger portions, thicker bread slices, incl. with pasta etc.
More fruit - have as between-meal snack, include in breakfast, base for desserts
More veg - put in sandwiches, add to stews, soups, serve >1 with meal
Less fat - bet aware of hidden fats, cut fat off meat, skin off poultry, avoid frying (grill, microwave), choose lower-fat milks, cheeses and spreads
Less sugar - don’t add, select sugar-free, fruit instead of pudding, tinned fruit in juice not syrup
Less salt - don’t add, flavour with herbs and lemon juice, buy tinned veg in water not brine ‘no added salt’

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20
Q

A healthy diet on a budget: guidelines

A

Plan >1 day ahead, shopping list; buy in quantities you will
use; supermarket brands
Try small amounts of new foods
Buy fruit and veg regularly (markets) and store carefully
Include generous helpings of starchy foods per meal (cheap, filling, healthy)
Buy leanest meat you can afford (mix with veg/pulses to
casseroles to go further); tinned/frozen fish and meat cheaper
Careful cooking re: fuel use e.g. water in kettle, toaster cf grill,
multiple dishes in oven, lids on saucepans, share (+shopping)
Beware processed foods (contents and cost)

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21
Q

Conception, pregnancy, breastfeeding

A

Maternal nutrient intake and birth weight correlation
Folic acid, vit A, oily fish
Iron
Males: zinc, alcohol, smoking

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22
Q

Menopause

A

Pre- and post-weight gain - risk of CVD, diabetes, cancer; often seen in African-Caribbean and Asian women
Osteoporosis (bone density fracture, Ca, activity, body shape, vit D)
<1.5mg day of vit A (bone fracture, liver/ products, supplements, including fish liver oil)
< vit D - Asian women susceptible, elderly, skin cancer
Soy protein (phytoestrogens) role: < symptoms (hot flushes) and heart disease, osteoporosis and cancer; less common in Japanese women

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23
Q

Adult gender differences: men

A

Conception, osteoporosis

50% over 40years will develop HD sometime during rest of life (50% of CV deaths) kills in 1 in 5 men

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24
Q

BMI calculation

A 
W (kg) / hxh(m)
Healthy weight for your height
<18.5 underweight
18.5-24.9 = healthy
25-27.9 = overweight
28+ seriously overweight (obese)
40+ morbidly obese
-overestimate with muscular build, underestimate in older and where muscle mass lost
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25
Alternatives to BMI
Waist-to-hip ratio, waist-to-height
26
Obesity
Toxins such as DDT and pesticides accumulate in fat tissue - present for long time Rapid weight loss --> release (500kCal/day)
27
Vegetarians
Lacto- (plant and dairy) and lactoovo- (plant, dairy, eggs) Total (vegan) = plant foods only Religious Economic and environmental
28
Vegetarians health benefits
Less CHD, strokes, cancers Less sat. fat Complex carbs, NSPs, fruit and veg (more antioxidants) Compatible with adult nutrient needs?
29
Veganism
Fortified soya products instead of dairy Pulses (e.g. kidney beans), nuts and seeds - instead of meat (non-haem iron) Less mineral absorption (e.g. binding to NSPs) plus time for GIT to adapt
30
Religious vegetarianism
Hinduism (pork and beef) Buddhism (lactoovo-vegetarian) Islam
31
Economic and environmental vegetarianism
30kg cattle food --> 1kg beef; increased cooking fuel
32
Nutrition and older people: ageing process
``` Starts once growth is complete at 25 years Frailty caused by physiological changes compared to physical decline due to mal/ undernutrition Degenerative changes -loss of smell, taste -failing sight -osteoarthritis/ osteoporosis -reduction of glucose tolerance -decline in muscle bulk and strength ```
33
Loss of smell, taste
20-60% loss in taste buds 60 years+ 65% loss 74-85 years Sweetness threshold 52-85 years 3x15-19 years
34
Nutrition and older people: other considerations
ill health, poor dentition, drug-nutrient | interactions, poverty/economic uncertainty
35
Nutrition and older people: contribution to health and recovery from illness
support, including well nourished, satisfactory well into 8th decade
36
Nutrition and older people: death
* infection, disease, accidents, gradual degenerative process * improved medical care and living standards * by 2030 25% of popn expected over retirement age (65yrs+) * young elderly 65-74yrs, older elderly 75yrs+
37
Nutritional requirements of older people
Same as younger adults, except < energy requirement and > vit D in housebound However may be difficult to achieve (poor appetite, in pain, have a disability)
38
Nutritional requirements of older people: reduction
Activity declines with age (less energy required) | Changes in body composition and function --> lower BMR
39
Nutritional requirements of older people: changes
Energy intake reduced (total amount of food eaten reduced) High nutritional quality, nutrient dense Not “eat less”, nor expect to lose weight as age
40
Older-aged people
* Smaller meals tolerated, with nutritious snacks * Enhance flavours * Minerals e.g. Ca - NSP affects absorption (osteoporosis) * Vitamins e.g. Vit A with cod liver oil for arthritis
41
Weight of older-aged people
Underweight • risk of morbidity and > mortality • lack of metabolic reserves for response to infection Overweight • more common in young elderly (osteoarthritis of knee)
42
Mal/ undernourished older people: general
Deficient in several nutrients | Self-neglect due to illness, depression, bereavement
43
Mal/ undernourished older people: specific
Deficient in a particular nutrient e.g. iron↓: poor teeth, cost, preparation - avoid meat vit C↓: fruit and veg intake decreases
44
Mal/ undernourished older people: sub-clinical
* diet poor but not show clinical signs * deplete body stores of nutrients * stresses lead to clinical mal/undernourishment
45
Causes of older mal/ undernourishment
``` Extreme age Social isolation and loneliness Loss of appetite Mental disturbances Physical disability Dental problems Dysphagia: swallowing difficult or painful Foods difficult to chew or swallow ```
46
Causes of older mal/ undernourishment: extreme age
> frailty increases risk
47
Causes of older mal/ undernourishment: social isolation and loneliness
~14% live alone; social contact aids well-being
48
Causes of older mal/ undernourishment: loss of appetite
• food enjoyment depends on visual appearance, taste, smell • smoking, poor OH, drugs • salivary secretion decreases - taste, chewing and swallowing (salivary gland dysfunction: Sjögren`s syndrome; xerostomia [drugs]; chemotherapy: mucositis, candidiasis)
49
Causes of older mal/ undernourishment: mental disturbances
Dementia - forget, lack of motivation
50
Causes of older mal/ undernourishment: dental problems
* 200-300kcal less intake due to poor-fitting dentures * due to discomfort * results in soft, bland diet; indigestion
51
Causes of older mal/ undernourishment: dysphagia
* MS, MND, CV attack, radiotherapy, surgery, confusion * IV fluids, fluid thickeners, gastrostomy feeding * speech-, occupational-, physio-therapists, dietitian
52
Causes of older mal/ undernourishment: foods difficult to chew or swallow
hard (toast, crackers, raw vegetables); chewy (meat); | sticky (mashed potato); crumbly (fruit cake)
53
Prevention of older mal/ undernourishment
``` Dehydration Home care assistants Meals on wheel Lunch clubs Institutions ```
54
Prevention of older mal/ undernourishment: dehydration
* 6-8 glasses, account for spills | * headache, constipation (disorders of GIT), UTIs, confusion
55
Prevention of older mal/ undernourishment: home care assistant
Buy and prepare
56
Prevention of older mal/ undernourishment: meals on wheels
Portability, loss of nutrients, punctuality
57
Prevention of older mal/ undernourishment: lunch clubs
Ideal | Less nutrient deterioration, social contact
58
Prevention of older mal/ undernourishment: institutions
* puréed food unappetising, taste similar if taste and smell decrease * sip feeds (Fortisip) * Percutaneous Endoscopic Gastrostomy (PEG) feeding
59
Good news
Food labelling better; traffic light system More choice (air miles, seasonal, cheaper ranges) Use by - safety Best before - quality
60
Use by - safety
``` Listeria: if ↓immunity: e.g. 60yrs+, transplants, drugs or cancer affecting/of immune system (un- and pasteurised soft cheese, paté etc.) ```
61
National Diet and Nutrition Survey
Year 1 2008/2009 (yr2 ‘09/’10 etc) • Food consumption, nutrient intakes & nutritional status 1.5yrs+ living in private UK households • Commissioned by FSA in 2006 (+DH/PHE funding) • Socio-demographics, physical measurements, age & gender • 3,000 individuals, cross-sectional • Intake comparisons with government recommendations & previous surveys Currently years 5-6 published Sept 2016
62
First food survey
1986/87 Dietary and Nutritional Survey of British Adults
63
1992/93 NDNS
Stand alone | Repeated 3 yearly until 2000/01
64
NDNS (RP)
• rolling programme • interviews, diet-diary, main food provider (purchase, prepare), nurse visits, blood, urine • different data, but can compare previously • continuous, cross-sectional data • new in `11/`12 - blood indices of nutritional status and 24 hr urinary sodium in children and older adults
65
Diet in adults: NDNS RP
• Adults 19-64yrs , 65+ • High quality, nationally representative data • Overall diet and nutrient intakes similar to previous assessments • Alcohol (58% and 51% in 4 day recording period) • Takeaways/eating out Fridays and Saturdays* • High meat and vegetable intake on Sundays* *but still some bias on weekends days even though sample days changed • Vegetarian, smoking, obesity, blood pressure
66
NDNS results in adults
• 27% (19-64yrs) and 35% (65yrs+) meet 5-a-day target • Oily fish: below and no change over time • Processed meat: women met recommendations in both age groups, men exceeded, BUT mean consumption reduced (74g (yrs 1 and 2), 68g (yrs 3 and 4), 65g (yrs 5 and 6)) • Saturated fat: above recommendations and no change over time • Sugars (NMES): above recommendations • NSPs: below recommendations • Vitamins and minerals: less than RNI • Salt: above

Nutrition (13 decks)

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