NUTR2003 Flashcards
1
Q
What is food security?
A
Physical, social and economic access to sufficient, safe and nutritious food that meets preferences/dietary needs at all times
2
Q
What is food insecurity?
A
Lack of availability of nutritionally adequate and safe foods or limited ability to acquire acceptable food in socially acceptable ways
3
Q
What are some causes of malnutrition?
A
- Lack of care or healthcare
- Lack of sanitation
- Lack of Support for mothers on appropriate child feeding
- Insufficient access to affordable nutritious food
4
Q
What is alcohol?
A
A fermented carbohydrate; a product of the metabolism of sugar by yeast.
5
Q
Where is alcohol metabolised?
A
liver
6
Q
What are the negative effects of alcohol?
A
- dehydration
- increases HR
- peripheral vasodilation
- alters judgement
- thiamine deficiency
7
Q
What are the functions of fat in the body?
A
- Insulation
- Structural component
- Roles in metabolism
- Vehicle for intake & absorption of fat soluble vitamins
8
Q
What are lipids?
A
- insoluble in water
- Composed of C, H, O
- Carbohydrate are easily converted to fat in body
9
Q
Where can fat be stored?
A
Adipose tissue
10
Q
What do the presence of double bonds in lipids dictate?
A
type, role, function, health effect
11
Q
What does the overconsumption of protein lead to?
A
- Weight control
- Heart disease
- Cancer
- Adult bone loss (osteoporosis)
- Kidney Disease
12
Q
What does insufficient protein intake lead to?
A
- Marasmus
- Kwashiorkor
- Wernicke-korsakoff syndrome
- Bone health impacts
13
Q
What are complementary proteins?
A
combining plant foods that together contain all the essential amino acids
14
Q
What makes a high quality protein?
A
- contain all the essential amino acids
- animal foods contain all the essential amino acids
- plant foods tend to be missing one or more essential amino acids
15
Q
What is dietary fibre?
A
- Dietary fibre provides structure in plants
- Cannot be broken down by human enzymes
16
Q
What are soluble fibres?
A
Soluble fibres are viscous and can be digested by intestinal bacteria (fermentability). Found in fruits and vegetables.
17
Q
What are insoluble fibres?
A
Insoluble fibres are non-viscous and are not digested by intestinal bacteria. Found in grains and vegetables.
18
Q
What are storage carbohydrates?
A
glycogen and starch
19
Q
What are the two monosaccharides?
A
glucose and fructose
20
Q
What are the three disaccharides?
A
sucrose
maltose
lactose
21
Q
What do nutritional needs depend on?
A
- Age
- Body size
- Gender
- Genetic traits
- Growth
- Illness
- Lifestyle habits
- Medications
- Pregnancy and lactation
22
Q
What is energy balance?
A
- Food in vs energy out
- Need to consider Basal metabolism and Thermogenesis as this burns calories
23
Q
What does an empty stomach trigger?
A
- Triggers gastric contractions
- Signals hunger
- Changes in hormones
24
Q
What is the most satiating macronutrient?
A
Protein
25
What is the NHMRC Evidence review ?
1. Defining the question
2. Planning the evidence search, analysis and reporting
3. Searching for evidence
4. Selecting evidence
5. Checking evidence for bias
6. Describing the body of evidence
7. Assessing the certainty of evidence
8. Presenting results and reporting
26
What are some of the factors influencing what people eat?
- social
- cultural
- environmental
- socioeconomic
- individual lifestyle
27
What are the AU dietary guidelines?
1. To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs
2. Enjoy a wide variety of nutritious foods from these five groups every day
3. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol
4. Encourage, support and promote breastfeeding
5. Care for your food; prepare and store it safely
28
What is the recommended carb intake?
45-65% of calories
29
What is the recommended protein intake?
10-35% of calories
30
what is a high quality protein?
contain all the essential amino acids
31
what is the recommended intake of fats?
- 20-35% of calories from fat
- <10% from saturated fat
- <1% trans fats
32
What are the fat soluble vitamins
ADEK
33
What is a result of micronutrient deficiency?
- Depletion of tissue reserves
- Decrease blood nutrients
- Insufficient nutrients to cells
- Impaired cellular function
- Physical symptoms
34
What is a result of micronutrient toxicity?
- saturation of tissue reserves
- increase blood nutrients
- excessive nutrients to cells
- Impaired cellular function
- Physical symptoms
35
What are vitamins?
- Cannot be synthesised by the body: needed through diet, bacteria, sun etc
- Required for growth, maintenance, reproduction and lactation.
36
What is bioavailability
Bioavailability is the rate and extent that a nutrient is absorbed and used.
37
What are vitamin precursors?
Precursors/provitamins are consumed in an inactive form and become active vitamins in the body
38
What are functions of vitamin A?
- Vision
- Healthy skin
- Cell differentiation
- Reproduction, foetal development, growth and maintenance of bones, teeth, and cell structure
- Beta carotene works as an antioxidant
39
What is a result of Vit A deficiency?
- Night blindness
- Lowered immune system
- skin keratinisation
40
What is a result of Vit A toxicity?
- Orange skin
- Fatigue, weakness, severe headache, blurred vision, hair loss and joint pain.
- Severe liver or brain damage
- Birth defects
41
What are sources of vitamin A?
- Leafy green vegetables
- Orange and yellow vegetables
- Tomatoes
- Fruits (mango, cantaloupe)
- Liver
- Fish oils
- Milk/Eggs
42
What are the functions of Vitamin D?
- Building and maintaining bones and teeth
- Absorption and utilisation of calcium
- Boost immune system
- Brain and nervous system (dementia and Alzheimer's)
- May also help decrease certain cancers
43
What is a result of vitamin D deficiency?
- Inadequate diet : Vegetarianism, lactose intolerance, milk allergy
- Body unable to absorb needed vitamin D
- Limited exposure to sunlight;
- Dark skin
- Cultural practices
- Older people
44
What is a result of vitamin D deficiency in children?
- Inadequate calcification of bones
- Growth retardation
- Bowed legs
- Enlargement of the ends of long bones
- Deformities of ribs, rachitic rosary of rickets
- Lax muscles (resulting in a protruding abdomen) and muscle spasms
45
What is a result of vitamin D deficiency in adults?
Osteoporosis and osteomalacia
46
What are sources of Vitamin D?
- Synthesised in the body from cholesterol
- Sun exposure for 10 minutes a day
Foods:
- Fortified milk, butter, margarine
- Tuna, salmon, egg yolks
- Vegans may need a supplement
47
What are functions of vitamin E?
- Important to red blood cells, muscles and other tissues
- Antioxidant
- Deficiency and toxicity is rare
48
What are sources of Vitamin E?
- Vegetable oils, salad dressings, whole grain cereals, green leafy vegetables, nuts, seeds, peanut butter and wheat germ, liver and egg yolk
49
What are functions of vitamin K?
- Important for blood clotting
- Bone health
- Mostly made in intestines by gut bacteria
- Babies born with sterile gut: need vitamin K injection
50
What is a result of Vitamin K deficiency?
- haemorrhaging
- Secondary deficiencies may occur with use of antibiotics.
51
What is a result of Vitamin K toxicity?
- No known toxicities
- High doses can decrease the effectiveness of anticlotting medications.
52
What are sources of Vitamin K?
- Bacterial synthesis in the GI tract,
- Turnip greens
- cauliflower
- spinach,
- liver
- broccoli, kale and cabbage
53
What are water soluble vitamins?
B group and C
- Absorbed directly into the blood and travel freely
- Very active in body. Several B vitamins form part of coenzymes involved in release of energy
- Participate in metabolism and cell multiplication.
- Can be destroyed by exposure to light, oxidation, cooking, and storage
54
What are the functions of thiamin/B1?
Helps convert carbohydrates to energy as part of the coenzyme thiamine pyrophosphate (TPP).
55
What is a result of B1 deficiency?
Fatigue, nausea, depression, nerve damage
56
What are sources of B1?
Pork, beef, liver, peas, seeds, legumes, whole-grain products, oatmeal, vegemite
57
What are the functions of riboflavin/B2?
Key to metabolism and red blood cells
58
What is a result of B2 deficiency?
- Dry, scaly skin
- Sore throat
- Cracks and redness at the corners of the mouth
59
What are sources of B2?
- Milk, yogurt, cheese, whole-grain breads, green leafy vegetables, meat, and eggs
60
What are the functions of niacin/B3?
- Involved with energy production
- Helps with skin, nerves and digestive system
61
What is a result of B3 deficiency?
Rare, but causes: diarrhea, dermatitis, dementia and death
62
What are sources of B3?
- Meat, poultry, liver, eggs, brown rice, baked potatoes, fish, milk, and whole-grain foods
- The body can make niacin from the amino acid tryptophan in the body
63
What are the functions of pyridoxine/B6?
Involved in chemical reactions of proteins and amino acids
63
What is a result of B6 deficiency?
Skin changes, dementia, nervous system disorders and anemia
64
What are sources of B6?
Lean meats, fish, legumes, green leafy vegetables, raisins, corn, bananas, mangos
64
What are the functions of cobalamin/B12?
Helps with nervous system, red blood cells and DNA synthesis
65
What is a result of B12 deficiency?
Nervous system disorders and pernicious anemia (elderly)
66
What are sources of B12?
- Only found in animal products
- Meat, fish, poultry, eggs, milk products and clams
67
What is the role of folate?
- Red blood cell formation, DNA synthesis, cell division, helps the body make new cells
- Part of coenzymes
68
What is a result of folate deficiency?
- Anemia, digestive disorders, Spina Bifida (neural tube defects), heart disease
- Very vulnerable to medications
69
What is a result of folate toxicity?
- masks B12 deficiency
70
What are sources of folate?
- Leafy, dark green vegetables
- Vitamin C increase absorption
- Also found in liver, beans, peas, asparagus, oranges, avocados
71
What are the important populations of folate?
- Additional requirements in women planning/during a pregnancy
72
What is a folate intervention?
Mandatory folate fortification of wheat flour
73
What is a role of Vitamin C?
Important to bone health, blood vessel health, cell structure and absorption of iron
74
What is a result of deficiency with vitamin C?
- Rare, but can cause poor wound healing, frequent infections
- Scurvy
75
What is a result of toxicity with vitamin C?
Diarrhoea and nausea
76
What are food sources of Vitamin C?
Melons, berries, tomatoes, potatoes, broccoli, fortified juices, kiwi, mangos, yellow peppers and citrus fruits
77
What are symptoms of scurvy?
- bleeding gums and loosened teeth
- poor wound healing
- frequent infections
- pinpoint haemorrhages
- fragile bones and joint pain
- rough skin and blotchy bruises
- muscle degeneration & pain
- hysteria and depression
78
What do binders do to minerals?
- Binders in food can combine chemically with minerals and prevent their absorption.
→ Phytates in legumes and grains.
→ Oxalates in spinach and rhubarb.
79
what are the major minerals?
Include calcium, chloride, magnesium, phosphorus, potassium, sodium, and sulphur
80
what are the trace minerals?
Include iron, zinc, iodine, selenium, copper, manganese, fluoride, chromium, molybdenum, arsenic, nickel, silicon, boron and cobalt
81
What is the role of sodium?
- Helps maintain fluid balance
- Helps transmit nerve impulses
- Influences contraction and relaxation of muscles
82
What occurs in excess sodium?
- Causes high blood pressure
- May lead to fluid retention
- Role in Osteoporosis
83
What is the role of potassium?
- Associated with fluid balance
- Low potassium intakes increase blood pressure.
- High potassium intakes prevent and correct hypertension
84
What is the role of calcium?
- The most abundant mineral
- 99% is stored in the bones
- Required for bone health
- disease prevention
- Hypertension
- Obesity
- Osteoporosis
85
what is the role of phosphorus?
- Mineralisation of bones and teeth
- Important in energy metabolism & energy transfer part of every cell
86
what are sources of phosphorus?
Dairy products, meats, poultry, fish, eggs, nuts, legumes, vegetables & grains
87
What are the roles of iron?
- Oxygen transport (red blood cells)
- Enzymes: most contain iron
- Immune system: fight infection
88
What is a result of iron deficiency?
- Too little iron= too little oxygen
- Anaemia
- Impaired immunity
- Impaired cognitive function
- Adverse pregnancy outcomes
89
What are sources of iron?
- Heme iron: animal sources (red meats, liver, poultry & eggs)
- Non-heme iron: plant sources (beans, nuts. Seeds, dried fruits, fortified breads & cereals)
90
What are roles of zinc?
- Helps make parts of DNA and RNA, manufactures haem for haemoglobin, assists in essential fatty acid metabolism, releases vitamin A from liver stores
- Metabolises carbohydrates and alcohol, synthesises proteins
- Disposes of damaging free radicals
- Involved in growth, development, and immune function
- Affects platelets in blood clotting and wound healing
- Needed to produce the retinal form of vitamin A
- Affects thyroid hormone function
- Influences behaviour and learning
- Taste perception
- Sperm and foetal development
91
What are symptoms of zinc deficiency?
- Growth retardation
- Delayed sexual maturation
- Impaired immune function
- Hair loss, eye and skin lesions
- Altered taste, loss of appetite
- delayed wound healing.
92
what are sources of zinc?
Oysters, meat, fish, milk, legumes
93
What is the role of iodine?
- Essential component of thyroid hormone (regulate metabolism)
- Regulates body temperature, growth, development, metabolic rate, nerve and muscle function, reproduction, and blood cell production.
94
What is a result of iodine deficiency?
- Impaired intellectual development
- Goitre
- Cretinism
95
what are sources of iodine?
Iodised salt, sea food, produce from iodine rich soil, fortified products
96
What are roles of fluoride?
Formation of teeth and bones; helps resist tooth decay
97
What is an EAR (Estimated Average Requirement) ?
A daily nutrient level estimated to meet the requirements of half the healthy individuals in a particular life stage and gender group.
98
What is an RDI (Recommended Dietary Intake) ?
The average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (97–98 per cent) healthy individuals in a particular life stage and gender group.
99
What is an AI (Adequate Intake)?
[used when an RDI cannot be determined]
- The average daily nutrient intake level based on observed approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate.
100
What is an EER (Estimated Energy Requirement) ?
- The average dietary energy intake that is predicted to maintain energy balance in a healthy adult of defined age, gender, weight, height and level of physical activity, consistent with good health.
- In children and pregnant and lactating women, the EER includes needs associated with the deposition of tissues or the secretion of milk at rates consistent with good health.
101
What is an UL (Upper Level of Intake) ?
- The highest average daily nutrient intake level likely to pose no adverse health effects to almost all individuals in the general population.
- Above the UL, the risk of adverse effects increases.
102
What is AMDR (Acceptable Macronutrient Distribution Range) ?
- Estimate of the range of intake for each macronutrient for individuals (%), which would allow for an adequate intake of all the other nutrients whilst maximising general health outcome.
103
What is an SDT (Suggested Dietary Target) ?
- A daily average intake from food and beverages for certain nutrients that that may help in prevention of chronic disease.
- Average intake may be based on mean/median depending on available data.
104
What is a dietary assessment?
Collection of information on food/drinks consumed over a specified time that is processed to compute intakes of energy, nutrients and other dietary constituents using food composition tables.
105
Direct Methods (Retrospective vs prospective)
Explain the difference in methods
Retrospective
- information on foods and beverages already consumed
- Examples: food frequency questionnaire, diet history, 24-hour recall, screeners
Prospective
- all food and beverages recorded at the time of consumption
- Examples: weighted food record, estimated food record 3/7 day diet diary
106
What is a Food Frequency Questionnaire ?
- a limited checklist of foods and beverages with a frequency response section for subjects to report how often each item was consumed over a specified period of time.
- Semi-quantitative FFQs collect portion size information as standardized portions or as a choice of portion sizes.
107
What is a 24-hour diet recall ?
- Recorded intake of 24 hours prior to interview
- Includes types of food, amounts and timing
- Estimate total intake of food, beverages, food energy, nutrients and non-nutrient food components consumed by the Australian population, to assess dietary behaviors and the relationship between diet and health.
108
What is Dietary Scores (Sceening) ?
- Used to measure the frequency of consumption without including information on portion size or dietary behavior
- Not recommended to use when trying to measure precise intake levels
Example: Minimum Dietary Diversity-Women (MDD-W)
109
What is fertility impacted by?
- Diet
- Smoking, alcohol, drugs
- Exercise behaviours
- Disease and illness
- Body weight
- Chemicals and toxins
110
How does body weight affect fertility?
- Body fat levels (low and excessive) are linked to infertility in both women and men
- Changes in hormone concentrations
- Small changes in weight (5-10% body weight) towards a healthy weight can greatly improve fertility
111
What is undernutrition?
Includes being underweight for one's age, too short for one's age (stunted), dangerously thin (wasted), and deficient in vitamins and minerals (micronutrient malnutrition).
112
What is malnutrition?
refers to both undernutrition and overnutrition.
113
What is Acute undernutrition?
- appears to have the greatest impact on fertility, though is likely to improve with dietary changes towards recommendations for good health.
114
What is chronic undernutrition?
likely to impact on the baby’s health e.g. low birth weight
115
What is low sperm count associated with?
- Undernutrition or being overweight
- Abdominal obesity
- Alcohol consumption (heavy/binge)
116
What improves male fertility?
- Adequate Zinc intake
- Antioxidants
117
What has a negative impact on fertility for females?
- Saturated (vs trans) fats
- Refined carbohydrates
- Added sugars
- No clear link between caffeine and fertility in humans
- Alcohol (binge/heavy drinker) lowers chance of conception
118
What has a positive impact on fertility for females?
- Diet containing more vegetable (vs animal) protein
- Low glycemic load
- Antioxidants (reduction of oxidative stress and free radicals)
- Mediterranean dietary patterns
- Dietary fiber, omega-3 (ɷ-3) fatty acids
119
What lifestyle factors impact fertility?
- Physical activity
- Stress
- Cigarette smoking and drug use
- Environmental toxins
120
What is pre conception care?
- Set of interventions that are to be provided before pregnancy, to promote the health and well-being of women and couples, as well as to improve the pregnancy and child-health outcomes.
121
What are the 1000 days of pregnancy?
The first 1000 days includes:
- Pregnancy
- 1st year
- 2nd year
122
What does each trimester signify?
Trimester 1: weeks 1-12
- Blastocyst implantation, embryo development, placenta formation, organ formation
Trimester 2: weeks 13-27
- Foetus practicing breathing and movement, organ development
Trimester 3: weeks 28-40
- Body and organ growth
- Rapid increase in body fat
123
Why is the first 1000 days so important?
- Significant growth and development
- Up to 22g growth per day
- Nutrition influences ability to grow, learn and rise out of poverty
- Foundations for optimum health and development across the lifespan are established.
- Physical and mental growth can be stunted for life and can be irreversible if nutrition is deprived
124
What are Foetal Origins of Adult Disease (FOAD)?
- Risk factors from intrauterine environmental exposures affect the foetus’ development during sensitive periods, and increases the risk of specific diseases in adult life
- Period of ‘developmental plasticity’ → periods where an organism is “plastic” or “sensitive” to its environment
125
What are the 10 building blocks for nutrition in the first 1000 days?
1. Nutritious diet in pregnancy
2. Good care in pregnancy
3. Exclusive breastfeeding for 6 months
4. Nurturing, responsive, care of feeding for babies and toddlers
5. Right foods introduced at right times for babies.
6. Healthy and nutritious diet for babies and toddlers
7. Water and beverages with no added sugars
8. Right knowledge and skills for parents to nourish children.
9. Consider access to enough nutritious foods
10. Societal investments for baby and toddlers
126
What are the increased pregnancy energy requirements?
- 1st trimester: No additional requirement
- 2nd trimester: Additional 1.4 MJ/day
- 3rd trimester: Additional 1.9 MJ/day
127
Importance of iron in pregnancy?
- Adequate iron status for women improves conception and reduces early complications in pregnancy.
128
Impact of iron deficiency on pregnant women?
- Reduced physical performance
- Increased fatigue
- Reduced cognitive performance
- Increased risk of infection & hospitalisation
- Pre-eclampsia & bleeding
- Inhibited lactation
- Greater risk of perinatal mortality & morbidity
129
Impact of iron deficiency on foetus?
- Spontaneous abortion
- Premature delivery
- Intrauterine foetal death
- Low birth weight
- Hypertension
- Neurologic impairment
130
Do calcium requirements increase in pregnancy?
No. Absorption of intake increases during pregnancy so intake doesn’t actually need to
131
Importance of folate in pregnancy?
- Strong evidence for the role of folate in neural tube development in early pregnancy
- Inadequate folate intake linked to birth defects such as spina bifida
- Potential role in male fertility
132
Importance of iodine in pregnancy?
- Iodine stored in the thyroid and during pregnancy the thyroid is very active, producing about 50% more thyroid hormones.
- Additional iodine is needed to produce enough hormones to support healthy foetal development
- Essential nutrient vital for the healthy development of the brain and nervous system before birth
133
Risk of foodborne illnesses in pregnancy?
1. Listeria
- Type of bacteria
- Found in soft cheeses, sandwich meats, bean sprouts, prepared salad, chilled seafood and pate
- mild symptoms for women
- Can lead to miscarriage, stillbirth or infection of the new born baby
2. Salmonella
- Most common food poisoning
- Pregnant women at higher risk of severe illness
- Rare cases may trigger miscarriage or long-term complications for the mother
- High risk foods are raw and lightly cooked eggs and egg products
134
Alcohol and pregnancy
No known safe drinking level for women when pregnant
135
Caffeine and pregnancy
- Risk of miscarriage and stillbirth
- Pregnant women should limit caffeine intake to less than 200 mg per day
136
Is there a risk of fish intake on pregnancy?
pregnant women should choose fish with low level of mercury
Impact on foetus
- Impacts brain and nervous system
- May not be noticed until developmental milestones ( walking & talking ) delayed
- Memory, language and attention span can also be impacted
137
What is the normal weight gain for a woman in pregnancy?
10-14kgs
138
what does compromised nutrient intake lead to?
Short-term: increased risk of premature birth, low birth weight and other birth complications
Long-term: increased risk for the development of chronic disease later in life
139
What do low and large birth weights have complications with?
- Low birth weight: <2.5 kilograms (increased mortality and morbidity, growth and brain development issues and chronic disease later in life)
- Large for gestational age: >4.5kilograms (birth complications, increased risk for obesity later in life)
140
What are the 4 common micronutrient deficiencies?
- Iron
- Vitamin A
- Iodine
- Zinc
141
What are the causes of micronutrient deficiencies in pregnancy?
- Poverty
- Food Insecurity
- Lack of knowledge/education
- Heavy burden of infectious diseases
- Poor hygiene and sanitation
142
What are the consequences of micronutrient deficiencies in pregnancy?
Increased maternal morbidly, mortality, poor birth outcomes (low birth weight), neonatal mortality and subsequent childhood malnutrition
143
What are the concerns surrounding adolescent pregancy?
- Adolescence is a time of rapid growth → higher energy requirement
- higher risk of eclampsia puerperal endometritis, and systemic. infections
- higher risks of low birth weight, preterm delivery and severe neonatal conditions
144
What are the risks of being overweight in pregnancy?
Increased risk of gestational diabetes mellitus and hypertension
145
When is screening of gestational diabetes?
Screening in second trimester
146
What is Foetal alcohol spectrum disorder ?
- Alcohol crosses the placenta
- Can lead to low birth weight, intellectual disability, behavioural problems, distinct facial features, heart defects
147
What is the Dietary patterns impact on pregnancy ?
Vegetarianism and veganism
- non-haem iron is less well absorbed
- Vegan diet may require Vit B12 supplementation
Other lifestyle factors
- Smoking: increases risk of low birth weight
- Caffeine: decreases iron absorption, increase risk of miscarriage and low birth weight
148
Why is breastfeeding optimal?
- Best start to life
- Tailored to needs of infants
- optimal source of nutrition for the first six months of an infants life, and with complementary foods up to two years (or, continued until 12 months and beyond) of life
149
When and how long does breast development occur?
- Takes 3-5 years, commencing at puberty
- Remains inactive until pregnancy
150
What does the lactating breast consist of physiologically?
- Alveoli, small sacs of milk-secreting cells
- Ducts, transport the milk to the outside via the nipple
- Blood supply (nutrients), lymphatic system (removes waste), nerves (sensitive, hormones)
151
What does prolactin do in breast milk production?
Prolactin, stimulates production
- Prolactin is important to the next feed.
- The greater suckling, the more prolactin released, thus demand feeding is vital especially in first 6 weeks.
- More prolactin is produced at night, so night time feeding is important for milk production
152
What does oxytocin do in breast milk production?
Oxytocin, stimulates muscle contraction
- Transports the milk and helps the baby get the milk easily
- Can be triggered by the mother hearing her baby cry or by touching, smelling or seeing her baby
153
What is the composition of breast milk?
- lower protein than cow’s milks
- half of the energy in milk is derived from fat; reflects the weight status of the mother (concentration) and mother’s diet (composition); more fat in the hind vs fore milk
- micronutrients adequate independent of mother’s intake; low in iron and zinc, though both highly bioavailable
- antimicrobial, anti-inflammatory and immunomodulatory agents
154
what is colostrum?
- thick yellow fluid produced in the first days after delivery
- low energy and fat, high in protein, minerals and fat-soluble vitamins
- low volume (well hydrated from amniotic fluid and placenta)
- immuno-protective role
155
How much breastmilk does an infant drink?
- The volume of milk produced matches demand
- Milk intake for an exclusively breastfed infant is approx 1L per day, though changes in line with infant growth requirements
- Milk volume is thought to be consistent across women independent of nutritional status; with the exception of severe protein energy malnutrition
156
What nutritional requirements increase in a breastfeeding mum?
- Energy: additional 2000-2100 KJ/day
- Protein: additional e.g. 21 grams/day RDI, compared to non-pregnant/lactating 31-50year old
- Carbohydrate: to support additional energy requirements
- Fat: additional, esp. fatty acids from fish (enhanced visual acuity maturation and cognitive function)
157
Which Micronutrients in breastmilk partially dependent on diet?
- Vit A: unlikely to be a problem in Australia as widely available though can be low in developing nations
- B vitamins: likely adequate in a varied diet, especially including fortified grains
- Vit D: content is low in breastmilk but appears adequate with incidental sunlight exposure; women with dark skin, who cover themselves or live in dark place may require supplements
- Iodine: very sensitive to maternal iodine status and mild-moderate iodine deficiency in pregnant women has been found in Australia, recommend supplement
158
What dietary needs increase in breastfeeding women?
- Increased needs in vegetables and legumes
- Increased needs in grains
- Often recommend lots of healthy snacking to try and adhere to this high intake needs
159
What are the main concerns for a mother in breastfeeding?
- Sore or cracked nipples: check positioning and attachment
- Breast fullness and engorgement: express some milk prior to feeding
- Mastitis: painful breast possibly with flu-like symptoms, which can be treated with frequent milk removal, and possibly antibiotics
- Self-perceived milk insufficiency: uncommon though can occur due to severe illness, inadequate mammary tissue and stress and is best treated with increasing frequency of feeding or expressing
160
What are short term health benefits of breast feeding for an infant?
- Optimal source of nutrition for growth and development
- Increased bonding with mother
- Reduces infant mortality and provides protection against gastroenteritis, diarrhoea, respiratory tract infections, otitis media (ear) and sudden infant death syndrome
- There is a dose-response relationship and protection extends beyond breastfeeding
- Infections are a major cause of mortality and mobility especially in developing nations
161
What are short term health benefits of breast feeding for a mother?
- Stimulates uterus contraction: helpful for uterus to return to pre pregnancy state
- Increased bonding with infant
- May help return to pre-pregnancy weight
- Cost and time saving
162
What are long term health benefits of breast feeding for a infant?
- Improved cognitive performance
- Influences the development of the microbiome
- Probable reduction in risk of overweight and obesity and cardiovascular disease risk factors, such as hypertension and high cholesterol
- Reduced risk of type I and type II diabetes mellitus, coeliac disease, inflammatory bowel disease, allergy, and asthma
163
What are long term health benefits of breast feeding for a mother?
- Contraceptive effect, and therefore may delay another pregnancy
- Reduced risk of breast and ovarian cancer and type II diabetes mellitus (post gestational diabetes mellitus)
- Reduced risk of postnatal depression
164
What are the long term societal health benefits of breastfeeding?
- more efficient for economy
- improve health and economic outcomes
- prevent deaths
- increased intelligence
- Environmentally friendly product
165
What are the seven key indicators to promote breastfeeding?
- Paid maternal leave
- Breastfeeding practices
- Funding for breastfeeding programs
- Systems to track performance
- Community support
- Access to breastfeeding support
- Implementation of marketing code
166
What maternal conditions may prevent them being able to breastfeed?
- Consuming some chemotherapeutic and radioactive drugs
- Severe illness
- Active tuberculosis
- Breast cancer treatment
- Syphilis lesions on the breast
- Herpes simplex virus type 1
- Untreated brucellosis
167
Should mothers with HIV breastfeed?
- Risk of infants acquiring HIV through breastfeeding vs the risk of dying from diarrhoea, malnutrition or other disease
- “Mothers known to be HIV-infected should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breast feeding.” ....while been fully supported for antiretroviral adherence
168
What lifestyle factors impact ability to breasfeed?
- Nicotine, alcohol, and other drugs have a harmful effect on infants
- Smoking and moderate alcohol use should not prevent breastfeeding, although encouraged to abstain
- Infants exposed to smoke have higher rates of respiratory disease and breastfeeding provides protection
- Alcohol can impact on lactation and infant sleep-wake patterns and psychomotor development
169
What are the priority populations in breastfeeding?
- Aboriginal and Torres Strait Islander Mothers
- Culturally and Linguistically Diverse (includes migrants, refugees and asylum seekers)
- Mothers of preterm infants
- Caesarean births, obstetric or childbirth complications
- Young mothers
- Low socioeconomic status
- Obesity
- Low education
- Daily smoking
170
History of breastfeeding and Aboriginal peoples
- Reduces risk of otitis media
- Water supply, housing conditions and cost impact on use of infant formula
- poor nutrition and infections during pregnancy, with the aim of developing bicultural strategies to reduce the occurrence and effect of these conditions including low birth weight and preterm birth
171
How does family and community impact breastfeeding?
- Attitudes and support of those around the mother can have a significant impact
- Direct support from partners
- Peer support
172
How does employment and workforce impact breastfeeding?
- Breastfeeding rates are lower among employed mothers
Breastfeeding supported by:
- Maternity leave
173
What is parental leave?
- Eligible employees can get parental leave pay from either or both:
- the Australian Government under the Paid Parental Leave scheme
- their employer
- 22 weeks’ Parental Leave Pay
- paid at the National Minimum Wage
- no super
174
How can returning to work be supportive of breastfeeding mothers?
- Workplaces with flexible hours, access to breaks, supportive culture
- No legislation in Australia to give mothers in the paid workforce the legal right to paid breastfeeding breaks
- Determined on an individual basis with employer
- Employers are obligated by the legislation to take reasonable measures to accommodate breastfeeding needs
- Federal Sex Discrimination Act 1984 prevents discrimination against breastfeeding women
175
Breastfeeding as a human right
1. Convention on the Rights of the Child (United Nations, 1989)
- Nutrition is recognised as critical to the rights of children
2. Convention on the Elimination of All Forms of Discrimination Against Women (United Nations, 1979)
- Equal access to health care, including pregnancy and postnatal care
- Mothers have the right to make decisions about their child’s life and their life
3. Statement, United Nations 2016
- “States should do more to support and protect breastfeeding, and end inappropriate marketing of breast- milk substitutes”
176
Breastfeeding in public laws
- All states and territories, and the Commonwealth Government have laws to protect mothers from discrimination when breastfeeding
- Must not be asked to stop breastfeeding in public
177
What are the laws regarding Restricting advertising and promotion of infant formula?
1. International Code of Marketing of Breast-milk Substitutes, WHO
- recognises that marketing and promotion of infant formula undermines breastfeeding
2. Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement (MAIF)
- voluntary, self-regulated code of conduct between manufacturers and importers; does not apply to retailers
- limited to formula targeting 12 months
- monitored by the public
3. Food Standards Australian New Zealand (FSANZ)
- standard regarding labelling of formula, i.e. doctor or health worker should be consulted before deciding to use formula
178
How does Breastfeeding address inequalities that stand in the way of sustainable development?
1. No poverty: natural and low-cost, affordable for everyone
2. Quality education: creates fundamentals for cognitive and mental development
3. Life below water: less waste compared to formula feeding
179
What is the rate of growth in babies?
- 150-200g per week in the first four months
- 100-150g per week up to six months
- At six months, on average, an infant will be double their birth weight; 2.5 times at 12 months
180
What are the important drinking developing milestones?
- rooting reflex (head toward touch, open mouth); sucking reflex (stimulated by pressure applied to palate by object); and swallowing and gag reflexes
181
What are the important eating developing milestones?
head control, sitting without support and gross motor skills (to pick up food, spoon, etc.), hand eye coordination, eruption of teeth
182
What are the changes in energy requirements for a baby?
- Highest per kilogram of body weight
- Changes, and infants can regulate their own intake when demand feeding
- Caregiver-led feeding may override natural satiety cues
183
What are the changes in protein requirements for a baby?
- Highest per kilogram of body weight, especially 7-12 months
- Essential for growth (of lean tissue)
184
What are the changes in fat requirements for a baby?
- Important nutrient for infants
- 55% of energy from breastmilk for instance comes from fat
- Fat restriction not recommended as it is needed for brain and other organ development
185
What are the changes in micronutrients for a baby?
- Vitamin A: limited risk of deficiency in Australia; maternal supplements for breastfeeding mothers in areas of high risk
- Vitamin D: depends on maternal status during pregnancy; regular, small doses of sun
- Iron: iron stores from 3rd trimester, with highly bioavailable iron in breastmilk, lasts for first six months
- Iodine is a recommended supplement
186
What is the composition of formula?
- Regulated by FSANZ
- Human milk is used as the reference (most made from cows milk)
- Reduced protein and electrolyte level, added iron and vitamins (including A, B group, C, D, E and K)
- Does not have living cells, cholesterol, polyamines, free amino acids, enzymes and a wide range of other bioactive substances.
187
What is the type of commercial infant fomula?
- Cow’s milk-based formulas are recommended
- Special formulas only used for specific purposes (e.g. made from soybeans, goat’s milk)
→ used under medical supervision where there are medical, cultural or religious reasons preventing cow’s milk formula use
- Special formula not recommended to prevent allergies
- Different formula based on age
→Infant (i.e. suitable from birth)
→Follow-on (i.e. suitable only for infants over six months). There is no evidence for advantages of follow-on formula over infant formula.
188
Preperation for formula
- Hygiene: wash hands, washing and sterilising equipment
- Water: boiled and cooled tap water (or still bottled water)
- Exact volume: using correct scoop and not over- or under-filling the scoop
- Safety: discard prepared formula that has been at room temperature for more than 1 hour
- Conditions: safe water supply, sufficient income, effective refrigeration, hygienic environment and provision for sterilising and storing equipment
189
When should solids be introduced and why?
At around six months:
- Infants are physiologically and developmentally ready for food
- Breastmilk alone no longer meets an infants nutrient needs
190
Developments at 6 months that show they are ready for solids
- Stores of some nutrients declining, especially iron
- Feeding behaviour has progressed: sucking to biting
- Tongue-extrusion reflex has disappeared
- Sitting
- Swalling their saliva and not drooling
- Imitating eating behaviours
- Digestive system is maturing
- Interest in environment
191
What happens if solids are introduced too soon?
- Displace breast milk
- Reduced breastmilk production
- Tongue-extrusion reflex may result in the infant rejecting objects
- Exclusive breastfeeding to six months reduces risk of allergies
- Pathogens in food may increase risk of diarrhoea
- Poor mastication → increased risk of choking
- Immaturity of kidneys and gastrointestinal tract
→ solids food increases volume of nitrates and solutes in food and can overwhelm kidneys→ dehydration
→ Pancreatic and intestinal secretions not fully produced- food can be undigested
→ Immature gut is more permeable (may let larger proteins into circulation and contribute to allergic sensitization)
192
What happens if solids are introduced too late?
- Growth faltering
- Micronutrient deficiency, especially iron and zinc
- Compromised immune protection
- Delayed development of motor skills such as chewing, and taste and texture acceptance
- Increased risk of developing allergic syndromes
- Later weaning in more beneficial in countries were there is increased risk of infection, poor sanitation, lack of appropriate weaning foods etc.
193
Type of solids to introduce
- Highly nutritious and represent variety from the five food groups
- Early food consumption is about the experience of food rather than nutrition
- No added salt (kidneys unable to excrete), sugar (dental caries, taste) or honey (prevent botulism)
194
Textures to introduce
- Puree, to mashed, to minced, to chopped
- Texture is important to oral motor development
- Finger foods by eight months, family foods by 12 months
- Avoid small, hard pieces of food (e.g. raw apple and carrot, nuts)
- Avoid small, round foods (e.g. cherry tomato, grapes) until 3 years to reduce choking risk
195
Store purchased baby foods recommendations
- Occasional use
- Lack variety of colours, textures, flavours, smells
- Priority should be given to foods with vegetables and meats
- Avoid desserts, custards and fruit bars.
- High in sugar low in iron
- Home made food is cheaper
196
What is baby led weaning?
- Infants are allowed to self-feed family foods in their whole form
- Infant chooses what and how much they eat
- Infant to be apart of family mealtimes
- Reported benefits for future development
- parents perceive it as positive impact upon diet, whilst practitioners perceive it as a risk
- Creates less sensitivity of texture
- Concerns from a healthcare practitioner: choking, growth faltering and iron intake
197
How much food do babies need?
- Initially, breastfeed baby first then provide first foods
- Very small amount to start
- One meal per day→ slowly building to three
- At 12 months, offer 5 small meals across day with breastmilk offered after
198
Signs infants have had enough to eat
- Look sleepy
- Turn their head
- Close their mouth
199
Allergy advice when introducing solids
- Include common allergy causing foods by 12 months in an age appropriate form
→well cooked egg and smooth peanut butter/paste, cow’s milk (dairy), tree nuts, soy, sesame, wheat, fish and other seafood
- May reduce the chance of developing food allergy
- continue to give these foods to your baby regularly (twice weekly)
200
What are dental caries?
- Where sugar from drinks or foods is in contact with teeth for a prolonged period, bacteria can convert this to acids which erode tooth enamel.
201
How to avoid dental caries?
- Do not put an infant to bed with a bottle
- Only breastmilk or formula and water to be given in bottles
- Formula made on fluoridated tap water
- If a dummie is used, never dip in honey, jam, etc. and clean under water
- Eat a healthy diet
202
Triple Burden of Malnutrition
- undernutrition: in the form of stunting and wasting and widespread micronutrient deficiencies.
- Growing prevalence of overweight and obesity
203
Long lasting impacts of malnutrition on?
- Physical & mental development
- Educational performance
- Employment opportunities
- Increased risk of chronic disease
204
What are gross motor skills?
run, jump, hop, throw
205
What are fine motor skills?
dress themselves, draw
205
What are language skills?
can express with hungry, thirsty, preferences, etc
206
What are examples of growth and development in a toddler?
- Develop independence and autonomy, with walking and talking
- Development of teeth- making chewing hard textures more effective
- Interested in exploring own environment
- Period of high emotions; and food is not exempt and food intake can be impacted
206
What are energy requirements for toddlers/pre-schoolers?
- Estimated energy requirements for up to two years considers age, gender weight, length & growth factor
- 2 years + recommends calculating BMR and applying appropriate physical activity level (PAL)
207
What are examples of growth and development in a pre-schooler?
- Developing relationships with peers and teachers which can influence eating patterns
- Up to that time, likely they have only spent time with family
- Change of perspective
207
What are the transitions of food in babies vs toddlers?
- Primarily solids vs primarily fluid
- Proficient with finger food, using cups and spoon
208
What are nutrient requirements for toddlers/pre-schoolers?
- Sets up healthy habits and taste preferences
- high requirements despite slowed growth
- nutrient dense foods for growth and increased PAL
- Continued growth & development →optimal nutrition intake important
- Weight gain: 2-3kg per year
- Height gain: 3-4 inches per year
- ↓ growth rate → ↓ appetite (may not be as hungry)
208
By 2 years old, what are the food changes that should be occurring?
- generally eat with toddler utensils (short but enlarged width handles)
- bottles should not be used (link to dental caries and obesity)
- Help prepare food
209
What are important nutrients for toddlers/pre-schoolers?
- Protein (growth of muscles, enzymes, hormones etc)
- B vitamins & Iron- energy metabolism
- Calcium & Vitamin D- bone development
- Fe, Zn may be lacking in their diets because they consume small portions of animal-rich foods
209
What are food requirements for toddlers/pre-schoolers?
- Small, frequent meals – three meals and two mid-meals (allows multiple attemps to meet requirements)
- Most children can self-select to meet appetite and energy needs
- Consumption may vary considerably from day-day and meal-meal
- Taste preferences can also change from day to day
- Low-fat dairy milks and dairy products can be used from 2 years
- Breastfeeding can continue
- No discretionary foods are recommended, however strict restriction is not ideal
210
What are physical activity requirements for birth to 5years?
- Should be encouraged from birth to 1 year: tummy time, grabbing
- Toddlers: 180 minutes a day doing a variety
- Preschool: same as toddlers but with 60 minutes of the 180 being energetic play
210
What are sedentary rules for birth to 5years?
- Infants shouldn’t be restrained for more than 1 hour at a time: in car, no screen time, etc
- Toddlers: shouldn’t be restrained for more than 1 hour at a time or sitting for extended periods. For children under 2, screen time is not recommended and at 2, screen time should be no more than 1 hour a day
- Pre school: shouldn’t be restrained for more than 1 hour at a time or sitting for extended periods. Screen time should be no more than 1 hour a day: less is better. When sitting, should be encouraged to read or do puzzles
211
What are fussy eating concerns for toddlers/pre-schoolers?
At 1-6 years, it’s common for children to be really hungry one day and picky the next.
- Children have different taste preferences from grown-ups
- Sudden shifts in food preferences are expected
- Life is too exciting for children sometimes, and they’re too busy exploring the world around them to spend time eating.
- Children learn by testing the boundaries of acceptable behaviour.
- They can be very strong willed when it comes to making decisions about food (to eat or not to eat, and what to eat). It’s all part of their social, intellectual and emotional development.
211
What are health concerns for toddlers/pre-schoolers?
1. Iron deficiency anaemia
- Paleness, irritability, shortness of breath, rapid heart rate, dizziness
- the answer? iron-rich foods+/-supplements; and treating any illness
2. Constipation
- may be linked to diet, though can be linked to issues with toilet training
- ensure adequate fibre and fluid
3. Dental caries
- Deciduous baby teeth help with speech and permanent tooth development
- sweet, sticky foods/beverages erode the enamel
- parents brushing, twice a day: start early even when they don’t have teeth to get them used to it
- fluoridated water to strengthen enamel
211
What are fussy eating tips for toddlers/pre-schoolers?
- Don’t punish or reward
- Force-feeding should be avoided. Hunger is the best means of getting a child to eat
- Normalize meal time: make it pleasant, sit as a family at the table
- Routine meal times and practices
- Positive language
- Eat as a family, remove stimulus (TV)
- Keep offering previously refused foods. Your child will probably try it and eventually like it
- Encouraging sharing
- Encourage your child to touch, smell or take a lick of the new food.
- Give a child small choices in the meal i.e. carrots or corn
- Encourage participation in meal preparation: eg. Mixing a salad, washing vegetables, whisking
- Fluids-limit drinks an hour before meals (suppresses appetite)
212
What are rules surrounding vegetarianism for toddlers/pre-schoolers?
- Appropriate with good management
- Iron: aim for 80% more than NRV; maximise Vitamin C with non-haem iron
- Calcium: calcium fortified alternatives if not consuming milk and dairy products
- Zinc and Vitamin B12: mostly found in animal foods, so care to be taken
212
What are factors influencing eating for toddlers/pre-schoolers?
1. Family
- lifestyle, culture, attitudes and knowledge
2. Advertising and marketing
- desire high- fat, sugar and salt foods
- numerous avenues, such as TV advertising
3. Child care settings
- policies, knowledge and setting
- increasing attention of others’ food choices
213
What are nutritional issues with formal care for toddlers/pre-schoolers?
- Approximately 50% of three year old Australians are in some form of child care
- Children in long-day care are likely to consume 50% of their intake from child care
- Food can be provided by the parent or the centre
214
What is the national Quality Framework for formal care?
- 2.2 Health eating and physical activity are embedded in the program for children
- 2.2.1 Healthy eating is promoted and food and drinks provided by the service are nutritious and appropriate for each child.
- 2.2.2 Physical activity is promoted through planned and spontaneous experiences and is appropriate for each child
215
What are Australian Dietary Guidelines for toddlers/pre-schoolers?
- Same serve size is the same for adults and children
- Recommended the amount of each serve presented at a single occasion is less
- Most children can self select an appropriate amount of food to meet their requirements
215
What are consumption concerns for toddlers/pre-schoolers?
- Daily consumption of sugar sweetened drinks -4% of 2–3-year old’s
- intake of sodium well above the level of adequate intake (1,484mg)
- Indigenous children, on average, consume about one-third fewer serves of fruit than non-Indigenous children.
215
What is considered for growth and development for children aged 6-12?
- Factors influencing growth: genetics, environment and health
- Important for growth rate to align with population norms, but tracking roughly along a percentile (CDC charts)
215
What are energy requirements for children aged 6-12?
- heat generation, muscle function, metabolism, physiological functions and growth and development
- vast differences in requirements according to growth and development rates (use NRV’s to estimate)
215
What is important for growth and development for children aged 6-12 relative to body size?
- growth is greater than that of adults and less than that of infants/toddlers
- will increase again towards adolescence
- Children can experience ‘bursts’ in growth: and eating!
- Start to gain a sense of body image, and ideal time to learn more about food and how it impacts on growth
- Become more socially aware of environment
216
What are the sedentary guidelines for children aged 6-12?
- Limit use of electronic media
- Break up long periods of sitting
216
What are consumption concerns of 4-8 year olds?
- Intake of sodium well above the level of adequate intake (2,058mg)
- About 1 in 5 girls have inadequate calcium intakes and about 1 in 10 have inadequate iron intakes.
- Indigenous children, on average, consume 40% fewer serves of fruit than non-Indigenous children.
- 43% children aged 4–8 do the recommended amount of physical activity each day
216
What are the physical activity requirements for children aged 6-12?
- 60 minutes to moderate-vigorous exercise daily
- Variety of aerobic activities
- 3 days a week should be exercises to strengthen bones and muscles
- More exercise is beneficial
217
What does family do to influence eating for children aged 6-12?
More than shared meals per week (compare to less than 3 shared meals per week) has been associated with more likely to be at a normal weight range and less likely to exhibit disordered eating
218
What are the parents role in influencing eating for children aged 6-12?
- boundaries and food rules (e.g. set times, eating at the table)
- healthy shopping
- persevere with vegetables/healthy foods
- positive attitudes towards efforts to try healthy foods and weight management (don’t say foods are good/bad)
- involve children
- main drink: water and milk
- use non-food rewards (such as if you eat all your dinner you get dessert)
219
How do peers influencing eating for children aged 6-12?
- increased exposure to peer pressure at school
- bullying if you don’t have specific foods
- wanting food that peers have
- increased social activity such as parties
219
What role does breakfast play for children aged 6-12?
- plays large role in learning and education
- positive effect on memory, attention span and creativity
- Not eating breakfast is associated with consuming more energy-dense, nutrient-poor foods throughout the day, cant retain information, less memory, more disruptive
- reduces risk of becoming overweight and obese
- School breakfast programs exist to reduce the number of students disadvantaged by poor nutrition
220
How do schools influencing eating for children aged 6-12?
- approximately 30% total energy is consumed at school
- tuckshops, market day stalls
- some studies have shown that students use the canteen to purchase unhealthy items
- need to promote healthy food choices
221
How does marketing influencing eating for children aged 6-12?
increased exposure to television and other forms of media
222
How do canteens influencing eating for children aged 6-12?
- guidelines for what should be supplied: there are national and state guidelines
- classify foods into ‘have plenty’, ‘select carefully’ and ‘have occasionally’
- colour coding
223
What is crunch and sip?
- promotes healthy eating
- challenge in ensuring parents can provide this
- generally strictly fruit in this small break
- allows teachers to discuss healthy eating
224
What are health concerns for children in schools?
- increase in Type 2 diabetes: due to reduced physical activity and increases in sodium and sugar intakes. Need to reduce glycaemic load by eating fruit and veg.
- overweight and obesity: linked to depression, low self-esteem, short stature.
225
What are the environmental causes for obesity in children?
- nutrient-poor energy dense foods which are marketed
- urban living leading to less incidental activity
- reduced perception of safety, reducing physical activity opportunities
- increased in dual-income families, impacting on foods consumed and physical activity opportunities
- decreased food literacy and cooking skills of family unit, impacts children
- increased use of small screen recreation by children, more sedentary behaviour
226
What are the complications of overweight and obesity in children?
1. Increased risk in the short-term:
- orthopaedic problem (growth, joints, bones)
- respiratory problems, e.g. sleep apnoea -> lack of sleep leads to educational struggles
- gastrointestinal problems, e.g. reflux
- potential psychological distress (bullying)
2. Increased risk in the long-term:
- Mortality
- morbidity, e.g. diabetes, hypertension, heart disease, stroke
- development of chronic disease
- more likely to require health services
- disability pension, asthma, polycystic ovary syndrome symptoms
227
What are the preventions and treatments of overweight and obesity in children?
- maintain growth and development whilst weight management Individual recommendations:
- no soft drinks at home
- non-food rewards
- packing healthy lunchboxes
- having healthy breakfast
- eating as a family at the table (not in front of the television)
- limiting screen time
227
What were the findings of PEACH?
- improved parental self-efficacy
- improved child eating behaviours (more vegetables, less sweet drinks and discretionary foods)
- increased child physical activity and less screen-based time
- 5% reduction in BMI (though most still above healthy weight) and therefore effective at scale
- higher attendance: advantaged families (two parent families, parents with higher education and self-referred) -> who are disadvantages families? How can we target them?
228
What is PEACH?
Parenting, Eating and Activity for Child Health (PEACH) is an overweight and obesity treatment program with the following elements:
- work as a family
- be role models as parents
- consistent parenting
- follow Australian Dietary Guidelines
- active often and in various ways
- make healthy choices the easy choice
- In the research setting, 10% reduction in BMI at 6 months, maintained at 18 months
229
What are key measurements of growth?
- Weight – similar circumstances each time
- Length – recumbent
- Head circumference
- Mid-upper arm circumference
229
What is growth?
Growth is the main indicator of nutritional status
229
What is pick of the crop?
Five Components
1. Farmer and Food connections; trying to bridge gap and show children where crops come from
2. Teaching and learning programs; embedded into school curriculum
3. Vegetable and fruit at schools: opportunity to consume these products at school
4. Healthy school environments
5. Parent connections
- Allows children to have a fun and engaging time with crops which encourages the intake of fruits and vegetables
230
What are growth charts?
- Pooled measurements from large samples of children, which are statistically smoothed to give percentile or z-score charts. (so we can see generally how children are growing)
- Compares growth rate against children of the same age
- Compares body mass index
230
What are the two main growth charts?
1. US CDC, 2000
- >1 million children and adults, though limited measures for 0-2 years
- Ethnically diverse
- Largely formula fed
- Percentile charts
2. WHO, 2006
- How children should grow, not how they do grow
- 8500 children in Brazil, Ghana, India, Norway, Oman and the United States
- Breastfed, of non-smoking mothers
- Percentile and z-score charts for more measures
Difference in these populations impacts results
230
Example of how growth charts can be read?
Bella
- Tracking okay at birth, then slight decrease, starts to plateau at growth
- Faltering growth is indication of concern
- Length and weight follow similar trends where they both start to plateau
- Z score is approaching -3 which is concern
- Not meeting requirements, weight changes first and then their length does, this creates concern
Archie
- Length is increasing with weight
- May be genetic and just a big baby
- Not considerable concern
- Would need to track growth and would be a concern if he kept significantly growing and excelling Z score
230
What are findings of Z scores?
- Important children are tracking in trends and not having sudden spikes or drops
- Z score is how many standard deviations childs growth is from median (positive is above median)
- Percentiles are generally used by dieticians as more people are familiar with this language
- Z scores are used as cut off; such as if child has a -3 Z score (only in NT), children will be admitted to hospital
- Can track online
- Wasting vs stunting: wasting is acute change that is happening and stunting is sustained wasting; drop weight first and continuing leads to growth impacts
- Important to measure both weight for length and length for age
231
What vitamin is required when an adult is vegan?
B12 as its only in animal products
232
Why may vegetarian eating be adopted in adolescent period?
- Animal welfare
- Environmental concerns
- Health reasons
233
What is the recommendation around free sugars contribution to an adolescent overall dietary intake?
Less than 10%
234
What is the recommended serve of calcium?
- 3.5
- Greater in adolescence as bones are intensively developing
- Protects against osteoporosis
235
How much adult bone mass is laid down in adolescence?
Over 50%
236
Three key micronutrients in adolescence
- Iron
- Zinc
- Calcium
- Folate
- Vitamin D
237
Name of 5 stages of sexual development
Tanner stages
238
Two main periods of rapid growth in human lifespan
- Early childhood
- Adolescent
239
How many adolescents complete the required physical activity?
1 in 5
240
What are girls commonly inadequate in for adolescence period?
- 40% have inadequate iron intakes
- 90% have inadequate calcium intakes
241
What is the sexual maturation for adolescents?
- Five stages of development (Tanner Stages)
- Useful in further understanding nutrition requirements as peak-velocity growth occurs:
- Stages 2 and 3 for females
- Stage 4 for males
242
What is their a link between for obesity in female adolescents?
link between obesity and earlier menstruation
243
What is the impact of individual factors on influencing adolescent diet?
- personal factors (e.g., body image, level of autonomy, preferences)
- psychosocial factors (e.g., attitudes, beliefs, self-efficacy, mood, mental health...)
- biological factors (e.g., appetite, hunger, taste..)
- Increased susceptibility to food fads, restrictive diets can lead to habits of skipping and substituting meals
244
What is the impact of social factors on influencing adolescent diet?
- Enhance social interaction can lead to influence of others on their decision making
- Social and emotional importance of peers increases
- increased eating out
- Peer influence occurs both in person and online
245
What is the impact of environmental factors on influencing adolescent diet?
- Consumption of discretionary foods (high sugar, high fat) is higher outside of the home e.g., school vending machines, retail food outlets, online food delivery apps and services
- Adolescent exposure to food messaging and marketing e.g., both physical food environment and online space (e.g., peer posting, online food advertising...)
246
Examples of eating disorders?
- anorexia nervosa
- bulimia nervosa
- binge-eating disorder
- orthorexia: hyperfocus on clean eating
- avoidant/restrictive food intake disorder
247
What is an eating disorder?
Psychological illness where individuals are preoccupied with food intake, exercise and body shape at a level which impacts on health.
248
What are the main adolescent health concerns?
- Energy drinks
- Added free sugars
- Alcohol
- Overweight/obesity
- Vegetarian
- Eating disorders
- Pregnancy
- Physical activity
249
What are the differences between weekends and weekdays for adolescents?
- Increased choice of discretionary food
- Added sugar intake significantly higher on weekends
- Fibre intake lower
250
What are the guidelines for adolescents and alcohol?
- Children under 18 should not drink alcohol
- Entices risky behaviour
251
What is the ‘Triple burden’ of malnutrition?
- Adolescents vulnerable to: Undernutrition, Micronutrient deficiencies, Overnutrition
- Both adolescent undernutrition and obesity coexist across low- and middle-income countries
- With overweight/obesity tending to be most prevalent in high-income countries
252
What are adolescent growth charts and what do percentiles indicate?
- Used when there are concerns surrounding overweight or growth faltering
- Overweight shows 85-97th percentile
- obese is over the 97th percentile
- Underweight is under the 5th percentile
253
What is the main concern of obesity in adolescence?
significantly increasing risk of developing chronic disease
253
What are the physical activity guidelines for adolescents between 13-17?
- At least 60 minutes per day of vigorous to moderate intensity exercise
- A variety of aerobic activities
- At least 3 days a week of exercise that strengthens bone and muscle
- Should engage in more activity; up to several hours a day
254
What are the sedentary behaviour guidelines for adolescents between 13-17?
Minimise sedentary time by limiting screen time and breaking up prolonged sitting periods
255
What are the requirements of iron in adolescents?
Increases to meet demands of rapid growth (increase blood volume & muscle mass) and for females the beginning of menstruation
256
What does inadequate iron lead to for adolescence?
- compromised growth
- decreased cognitive function
- physical performance and fatigue
- depressed immune function
257
What are the requirements for energy in adolescents?
- Adolescent requirements can be as high as that for adulthood
- Deficits may result in poor growth and failure to reach height potential (stunting)
258
What are the requirements for protein in adolescents?
- Required for synthesis of body tissues; improves dietary iron and zinc absorption
- AMDR: 15-20% of total energy
- Excessive protein intake will add to fat mass, lead to increased calcium excretion and additional load on the kidneys
259
What are the requirements for carbs in adolescents?
- Primary energy source for optimal brain function and to preserve protein for other functions
- AMDR: 45-65% total energy
- Preferred source: wholegrain products which contain more fibre and micronutrients
260
What are the requirements for fibre in adolescents?
- Associated with healthier bowel, improved blood cholesterol, blood glucose, blood pressure, lower weight
- Concern with the rise of processed foods
261
What are the requirements for zinc in adolescents?
High to meet requirement of growth and sexual development
261
What are the requirements for folate in adolescents?
- B-group vitamins required to assist in releasing energy for use for rapid growth
- Important in energy production
- Particularly important for pregnant adolescents
262
What are the requirements for fat in adolescents?
- AMDR: 20-35% total energy, with <10% from saturated fat
- Replacement of saturated fat with unsaturated fats is beneficial, however some saturated fats in some food sources may be protective for chronic disease (e.g., in dairy products).
- Consume omega-3 fatty acids regularly (oily fish, seafood, soy, seeds, nuts, dark green veg, canola, eggs)
263
What are the requirements for calcium in adolescents?
- More than 50% of bone mass is developed during adolescence
- Adequate calcium essential to achieving peak bone mass and reduce risk of osteoporosis
264
What are the requirements for vitamin D in adolescents?
- Sun exposure to be balanced with risk of skin cancer
- Where there is minimal outdoor time, food sources of Vitamin D (fortified milk, margarine and eggs) or supplement should be considered if serum levels are low
265
What are the similarities/differences between adolescent body composition between males and females?
- Males: greater muscle development, and proportionately less fat at ~16-18% (testosterone)
- Females: muscle mass continues to develop, though greater fat deposition at ~ 22-26% (oestrogen)
266
What is the main developments in early adolescence (10-13)?
- Adjusting to developing body
- Beginning of the development of moral concepts
- Friends are a strong influence, and family are less influential
- Approach to improving nutrition should focus on the now: to position them well for future
267
What is the main developments in middle adolescence (14-17)?
- Increased emotional independence from family
- Increase in health risk behaviours
- More comfortable with developing body
- Some financial independence
268
What is the main developments in late adolescence (17-21)?
- Physical development near completion and cognitive development close to adult-level
- Better understanding of self, beliefs, values
- Employed or tertiary studies
- Approach to improving nutrition can focus on link between present and future
269
What does the WHO framework of interventions and determinants of adolescent nutrition look at?
- Looks broadly at environment
- Looks at families and communities
- Interventions can look at healthy diets, physical activity, disease prevention, preventing adolescent pregnancy, promoting preconception
- Preventing malnutrition
270
What are the concerns surrounding added free sugars for adolescents?
- Consume on average 73g of added sugar per day: 18 teaspoons
- Higher for boys (82g) Vs Girls (63g)
- Recommended intake → less than 10% of total energy
- Contributors to added sugar intake
soft drinks, cakes and muffins, honey & syrups, juice
271
What are the key messages from Adolescent Nutrition 1?
- Time of transformative growth, both undernutrition and obesity affect multiple physiological systems
- A time of unprecedented change in food environments: difficult to make healthy choices
- Intergenerational impacts: a period of growth and development with profound consequence on individual’s health in later life
- Adolescent nutrition affect timing and form of puberty
- Nutrition sensitive window to promote healthy growth and reduce risk of obesity later in life
- Underinvested area of research
271
What are the key messages from Adolescent Nutrition 2?
- Dietary intake is the foundation for healthy life
- Adolescents are diverse in their dietary patterns/factors that influence food choice
- More evidence needed
- Adolescents must be active partners in shaping action
- Food environments are not conducive to healthy food choice
- Need:
- regulation/policy to improve the food environment
- empowering with knowledge/skills and motivation to navigate to a healthy/socially appealing diet.
272
What are the key messages from Adolescent Nutrition 3?
- Double burden: despite micronutrient deficiencies, overweight/obesity rapidly increasing
- A lack of targets/standardised data to inform action
- only focus on single micronutrient
- Need greater government policy action to restrict availability of highly processed foods and enhance healthy/diverse adolescent diets
- Greater retention in education means schools can provide healthy food environments, skills/knowledge and motivation to adopt and sustain healthy diets
- Advocacy in partnership with young people
273
What are the Adolescent Nutrition 3: Lancet series recommendations?
- Commit to adolescent nutrition through evidence-based systems
- Use policy to create healthy food environments
- Place adolescent nutrition advocacy within a broader ecological
context... (partner with young people in advocacy)
274
What is the importance of adolescence?
- Opportunity to shape health and wellbeing of this generation and the next
- Time of rapid physical growth and development and cognitive and emotional capacities.
- Age group that has been neglected in national and global policies
- Consider optimal healthy nutrition
- Largely impacted by parents, childhood nutrition and pregnancy
- Nutritional vulnerability increases in adolescence due to heightened nutritional requirements, yet the quality of diets often deteriorates
275
What are special considerations in vegetarian diets?
protein, iron, zinc, calcium, Vit D, omega-3 fatty acids, Vit B12
275
How is adolescence a missed opportunity?
- Inadequate focus, funding, and intervention on adolescent health
- Interventions and investments are needed in adolescence
- Stepping stone to larger transition into adults
- Greater visibility and understanding of adolescent food choices and their consequences
- Benefits later adult life and optimal growth of next generation
- Opportunity to interrupt intergenerational cycles of malnutrition
275
What are some individual, social, and environmental impacts of adolescent diet?
1. social: family meals, peer pressure, culture, social media, technology, support
2. individual: stress, genetics, awareness, time pressure, emotional eating
3. environmental: convenience, access, affordability, proximity, shelf-life
276
Tips to ensure a successful vegetarian diet?
- For adequate intake of all essential amino acids, a variety of plant-based protein foods are required, including grains, legumes, vegetables, nuts and seeds
- For adequate intake of iron, include Vitamin C containing foods with iron-containing plant foods
- Has been associated with reduced risk of obesity, hypertension, cardiovascular disease and cancer
277
In regards to height and weight, what are the Adolescent physiological development?
- Over 1.5 – 3-year time span: Females; 16cm and 16kg, Males; 20cm and 20kg
- Average height is increasing (nutrition and health, environments and health of the mother)
- Weight is disproportionally increasing
- Growth charts important in monitoring growth
278
What is skeletal growth like in adolescence?
- Period of rapid bone growth due to impact of sex, thyroid and growth hormone
- Bones are set and are at their longest within the timeframe of full adult stature (and will not change)
- Bones widen and become denser (and continue to increase in density until up to 30years)
- Over half of adult bone mass is laid down in adolescents
279
When is the full adult stature reached?
17 years for females and 21 years for males
280
Why are energy drinks a concern for adolescence?
- Stimulant, enhancing endurance performance and concentration at moderate levels
1. Caffeine toxicity
- palpitations, agitation, tremor, GIT symptoms and cardiac and neurological effects
2. Low-moderate intake
- disruptive and hyperactive behavior, sleep disturbance
- potentially long-term preference for food/drink associated with caffeine (i.e., sugar with caffeine in the case of energy drinks)
281
What does energy drinks with alcohol result in?
Masks feeling of being drunk
282
How does diet impact academic performance?
Glucose: Preferred energy source for the brain
- requires regular consumption of core foods throughout the day
Low glucose:
- Agitation and irritability (hormones, cortisol and adrenalin)
- Lack of concentration
Due to:
1. lack of food, or
2. foods delivering high glucose load (where insulin overcompensates)
283
What is the transition as a Young adult: 19-25?
- end of rapid growth
- true independence: working/studying, living, relationships
284
What is the transition as an Early to middle age adult: 26-65?
- most growth and development complete
- productive years: having families, working, contributing to economy
- multiple roles and responsibilities: balancing work, social, health promoting practices (what we should and shouldn’t eat)
284
What are the energy requirements of an adult?
- According to age, height, weight, muscularity and physical activity levels (PALs)
- In early adulthood, muscle mass can continue to develop, though starts to slowly decline in middle aged adults (need to work on trying to slow decline and maintain muscle mass), and so to does energy requirements
285
How is energy requirements determined?
- Basal metabolic rate (resting requirements) for certain age, weight and height are multiplied by a physical activity level (PAL)
286
When do water requirements increase?
- Increases for pregnant and lactating women, individuals in warm climates and those who are very active
287
What are the PALs?
1.2: at rest, sedentary
1.5: sedentary activity with little strenuous activity
1.7: predominantly seated work and occasional walking
1.9: predominantly standing or walking work
2: heavy occupational work
287
What are the Physical activity guidelines for 18-64 years?
- Any activity is better than none
- 150-300 minutes of moderate intensity physical activity or 75-150 minutes of vigorous intensity exercise or a combination each week
- Do 2 days a week of muscle strength training
287
What are the sedentary guidelines for 18-64 years?
- Minimise prolonged sitting
- Break up periods of sitting frequently
288
Moving more and sitting less will…
- Reduce risk of CVD
- Reduce risk of Type 2 Diabetes
- Maintain or reduce cholesterol, blood pressure
- Prevent unhealthy weight gain
- Build strong muscle/bones
- Socialisation
- Reduce risk of rehabilitation from some cancers
289
What is the Impact of alcohol, tobacco, drug use in adulthood?
- Increase of consumption in adulthood
- Drug induced deaths, burden of disease, pregnancy complications, mental health
- Risky behaviour, domestic violence, criminal activity, trauma
- Financial costs, household expenditure, lost productivity
290
How is BMI determined?
weight (kg) / height2 (metres)
291
Why are we concerned about overweight and obesity? The causation pathway for chronic diseases
1. social determinants: time, employment, cost of living
2. environmental determinants: loss of cultural diets
291
What is the waist to hip measurement?
- Another measure for weight-health related risk
- Related to central adiposity and increased risk of chronic disease
- Measure between lowest rib and top of hip bone, roughly in line with belly button
292
Underlying determinants of chronic disease
- globalisation
- urbanisation
- population aging
- social determinants
293
What is the australian burden of disease?
- Measures health gap with different between actual and ideal health
- YLD: years lived with disability
- YLL: years of healthy life lost: fatal burden
- When you add these two together, they applaud DALY; disability appointed life years
293
Risk factors of chronic disease?
- unhealthy diet
- physical inactivity
- air pollution
- tobacco and alcohol use
- age
- heredity
293
Where does the most disease burden come from?
- Cancer
- cardiovascular disease
- mental and substance use disorders
- musculoskeletal conditions
- injuries
294
Intermediate risk factors of chronic disease?
- raised blood sugar
- raised blood pressure
- abnormal blood lipids
- overweight/obesity
- abnormal lung function
295
Normal weight range would reduce?
- Diabetes
- Dementia
- Osteoarthritis
- Stroke
- Chronic kidney disease
- Breast cancer
- Bowel cancer
- Back pain
- Coronary heart disease
- Oesophageal cancer
296
Modifiable risk factors that prevent disease?
- tobacco use
- high BMI
- alcohol use
- physical inactivity
- high blood pressure
- poor diet
- obesity
297
Burden of disease attributable to diet low in veg?
big contribution of mouth and pharyngeal cancer and laryngeal cancers
298
Influences on dietary adult behaviour
- convenience
- culture
- eating habits of parents
- cooking capabilities
- education
- finances
- generational influences
- social media: ‘almond mum’
299
Six dimensions of food security
1. availability: having quality and quantity of foods to satisfy dietary needs
2. access (social, physical and economic): can afford food and have food sources/stores nearby that you can engage with
3. utilisation: adequate diet, clear water, sanitation and healthcare
4. stability: ability to ensure food security in event of sudden shocks (natural disaster, etc)
5. agency: all people at all times have ability to make choices on what they eat
6. sustainability: food choices that contribute to long term regeneration of natural, social and economic systems
300
Who suffers from food insecurity in Australia?
- unemployed people 23%
- single parent households 23% low-income earners 20%
- rental households 20%
- young people 15%
- Aboriginal Australians 24%
- Culturally and linguistically diverse people Socially isolated people
301
Other concerns in adulthood in addition of food security
Mental health
- can lead to issues that impact on education and employment and ultimately dietary intake
- nutritious diet (and adequate sleep) has been associated with reducing depression
Homelessness
- greater risk of compromised nutritional intake, in addition to a host of other factors impacting on health
Substance use
- varied psychological and behavioural effects
- addiction can impact their ability to both access and absorb food
302
Meal Delivery Apps
- can increase convenience of good and bad foods
- mediate the linkages between physical and digital food environments by connecting meal providers with customers via online platforms.
- current policy and legal frameworks do not apply to this component of digital food environments.
303
What are the two transitions of ageing?
1. “The Golden Years”
- Retirement
- Increase in eating out, alcohol consumption
- Connectivity to community
- Social groups
- Volunteering
- Provision of childcare
2. With advancing age
- Increasing illness and injury
- Home support required to complete daily activities
- Transition into aged care home if care needs are too great
304
Physiological Changes in older adults
1. Senescence: Cellular deterioration with ageing
- Signals an increased risk of disability, disease and death
- Systems begin to slow and degenerate
2. Sensory loss
- Alteration to sight, hearing, smell & taste (less taste buds)
- Dysgeusia: abnormal taste perception
- Medication use can alter these senses
3. Neurological function
- Reduced cognition due to ageing or dementia
- Depression
305
Body Composition Changes (gradual decline) in older adults?
- Lower mineral and water reserves
- Decrease in fat free mass
- Bone mineral density declines (hence why its optimal to increase calcium early on)
- Increase in Fat Mass
306
Physical Changes in older adults
1. Gastrointestinal
- Xerostomia: declined salivary production (dry mouth)
- Dysphagia: difficulty swallowing foods (due to muscles, less saliva)
- Poor dentition: difficulty chewing foods
- Achlorhydria: low gastric HCl production, limits calcium, iron, folate, vitamin B12 absorption (less absorption of nutrients)
2. Gut Microbiota
- Susceptible to food borne illness like in pregnancy
- Increased inflammation
- Decreased immune function of GI tract
- Impaired functioning of gut mucosal cells
- Bacterial overgrowth
307
Changes to organ function in older adults
- Less adaptable to environmental or physiologic stressors
- Kidneys: less able to concentrate waste (loss of nephrons)
- Liver: less efficient in breaking down drugs
- Pancreas: reduced blood glucose control
- Bladder control may decline
- Respiratory: declining vital capacity
- Connective tissues and blood vessels become increasingly stiff and less pliable (increasing blood pressure and hypertension)
- Neurons in the brain decrease: impaired memory, reflexes, coordination
- Decreased production of hormones: testosterone and growth hormone
308
Do the ADG apply to older adults?
do not apply to frail elderly at risk of malnutrition or people with medical conditions requiring specialised dietary advice
308
Changes to BMR in older adults
- Decreased energy needs from loss of muscle mass and lean tissue
- Lower basal metabolic rate
- Reduced activity levels
308
What is the issue for older adults and water intake?
Reduced thirst perception (can go whole day without water, especially with cognition issues), decline in kidney function and use of medication means its very important for the elderly to stay hydrated
309
What is protein consumption for older adults?
- Protein requirement increase over age of 70
- space protein consumption out due to decreased HCl production
310
Micronutrient changes in older adults
- Iron decreases for women after 51 years (menopause)
- Calcium increases for women after 51 years and men after 70 years (due to menopause and impact on bone mineral density)
- Requirements for B2, B6 and D increase (challenges with absorption)
- Vitamin B12: requirements don’t change but there can be impaired absorption
311
Physical activity guidelines for older adults
- Older people should do some form of physical activity
- Should be active every day with a range of activities
- At least 30 mins per day of moderate intensity physical activity
- Older people who have stopped physical activity should start at an easily manageable level
312
Current issues with older adults
- Intake is not adequate for calcium, grains, fruit, veg
- High levels of overweight and obesity
- Challenges in providing care for overweight people
- How do we support people in residential aged care with falls, access using wheelchairs, etc
- More likely to be overweight in later life if you were as a chuld
313
Unintentional weight loss and malnutrition in older adults
- Loss of subcutaneous fat and muscle wasting
- In the community 10% of older people are malnourished with a further 40%
at high risk of malnutrition
- One third of hospital patients (65yrs+) are malnourished with a further 50%
at high risk
- Any unintentional weight loss should be investigated
313
Nutrition concerns for older adults
1. Sensory loss
- Less interest/enjoyment in food
- Body is primed to absorb food before we start to eat such as smelling foods, if smell has deteriorate, body doesn’t get these cues and is not properly primed for digestion
2. Neurological function
- Decreased cognition, dementia
- Ability to shop/prepare food safely
- Loss of interest in eating (depression), mental health declining
3. Dentition, salivary glands, dysphagia
- Avoidance of tough foods, e.g. meat (reduced iron/protein intake)
- Dry mouth: increased difficulty eating/swallowing
- Alteration of the texture of foods (pureed): can decease intake as its not enjoyable
4. Early Satiety
- Potential decreased sensitivity to ghrelin
- Changes in function of CCK: feel fuller quicker
- Abnormalities in gastric motility
- Overwhelmed by the amount of food on the plate
314
Impacts of malnutrition on older adults
1. Skin Integrity
- Slow or non-healing wounds
- Increased risk of pressure ulcers = reduced mobility and sitting for prolonged periods
2. Increased frailty
- Reduced mobility
- Increased disability
3. Impaired immune function
- Delayed recovery: more susceptible as well
- Recurrent infections
4. Hospitalisation
- Increase hospitalisation rates
- Increased length of stay
- Increased risk of mortality
315
What does malnutrition look like in older adults?
- Pinch test: under bicep, very thin layer of fat
- Sunken and hollow area behind eyes
- Collarbones are more visible, protruding, bony and sunken, and the same with shoulders due to loss of muscle mass
316
What is starvation?
- Protein-energy malnutrition
- Inadequate intake of food
- Loss of lean muscle mass and fat mass
- Within Australia, generally caused by reduced appetite, difficulty with eating, early satiety, cognitive decline and inability to prepare food
317
What is cachexia?
(different type of malnutrition)
- Inflammation causing catabolic processes resulting in muscle and fat loss
- Known to also occur in cancer, HIV/AIDS and COPD, higher levels of inflammation in body where body is using a lot of energy to try and fight it off, hence the dramatic weight loss
- Can lead to anorexia: impacts on appetite and dietary intake and symptoms like nausea and vomiting
- Associated with decreased quality of life, functional capacity and mortality
- Treatment: medication to reduce inflammation and adequate intake of protein and energy
318
How to detect malnutrition?
- MST (malnutrition screenting tool) is a screening tool (flags a patient for dietetic review): any accidental weight loss?
- SGA (subjective global assessment): tool to diagnose malnutrition
319
How to treat malnutrition?
- Increase protein and energy intake
- Fortify foods or use of supplements: add nutrition to consumed foods
- Look for a potential cause; texture modification, diet liberalisation
- E.g. Sustagen and ensure plus, butter, cream, oil, milk powder
319
What is sarcopenia? And why is it a concern in old age?
- Age related loss of muscle mass, strength and function
- Impact on quality of life by decreasing mobility, increasing risk of falls and altering metabolic rates
- Exercise (weight bearing) is important for slowing down sarcopenia
- Sarcopenic obesity-loss of lean muscle mass with excess adipose tissue (double burden)
- Together excess weight & decrease muscle mass compound to further decrease physical activity, accelerating sarcopenia
- Important to not use weight as measure of health as 9/10 times is the muscle they are losing not fat which leads to severe functionality issues
320
What is osteoporosis? And why is it a concern in old age?
- Bone loss faster than replacement rate leading to low mineral bone density
- Air pockets form in bone
- Higher risks of breaks: fractures, pain, loss of function, independence
- Important to optimise bone health early in life to reduce risks
- Common sites of fractures; hip, spine & wrist (due to high pressure in joints and areas affected in falls)
- Calcium requirements increase
→ For women 51 years +; hormonal changes associated with menopause. Causes calcium balance to deteriorate, decline in intestinal absorption and increase in urinary calcium excretion.
→ Males requirements increase over 70 due to calcium absorption efficiency decreasing
321
Risk factors of osteoporosis
- Non modifiable: genetics, age, gender and menopausal status
- Modifiable: inadequate calcium and Vitamin D status, physical inactivity, smoking, alcohol misuse
- Corticosteroids and low socioeconomic status
322
Prevention and treatment of osteoporosis
- Adequate calcium intake and adequate exposure to sunlight OR supplementation
- Weight bearing physical activity to strengthen bone mass
323
What is the effect of hospitalisation on older age?
- Increased rates of hospitalisation
- Patients can become malnourished
- Being unwell: decreased oral intake
- Dislike of hospital food
- Set meal times
- Hospital environment not conducive to eating
- Fasting for medical procedures
- Hospital food: bland, lacking protein, too many veg, all packaged food (hard for older people to open due to less strength; don’t like interrupting nurses so just wont consume). Some people need to lay in bed to eat.
324
What is polypharmacy?
- Taking five or more medications daily due to managing multiple medication
- Older people have more chronic condition that require medication
325
What are side effects of polypharmacy?
- Nausea/vomiting
- Decrease appetite
- Constipation
- Decreased nutrient bio-availability
326
What is chronic disease?
- Prolonged health conditions
- Rarely cured completely
- Focus is appropriately managing symptoms, preserving function and minimizing further damage
- Not trying to cure symptoms but manage them
327
What are examples of chronic disease?
- Diabetes
- Heart Disease
- Arthritis
- High blood pressure
- Cancer
- Low Vision
- Depression
- Kidney Disease
328
What is the Leading causes of burden for older Australian’s
1. Cardiovascular disease and cancer
2. Neurological conditions
3. Musculoskeletal conditions
4. Respiratory conditions
329
Why is a focus on chronic disease important?
- Most prevalent and disabling conditions facing older people
- Can reduce quality of life
- Expensive for health care systems- account for 75% of medical care costs
330
Why is a focus on chronic disease important on an individual level?
- Loss of function
- Loss of mobility
- Loss of Independence
- Disability
- Pain
- Death
331
What can public health do to focus on chronic disease?
- Prevent the development of chronic diseases throughout the lifespan.
- Reduced incidence of chronic diseases
- Delayed onset of chronic diseases by optimising time period
332
What are Factors that accelerate ageing?
- Smoking habits
- Alcohol consumption
- Sun exposure
- Weight status (obesity, underweight)
- Level of physical activity
333
What are Factors affecting food choice in elderly?
- Loneliness and isolation
- Hospitalisation
- Depression
- Dentition
- Disability
- Chronic illness
- Access
- Mental health
- Institutionalisation
- Reduced taste perception
- Transport, mobility, income
334
What is the role of micronutrients promoting genomic stability?
- Omega 3 fatty acids and antioxidants (vitamins C and E, selenium, carotenoids and polyphenols) in DNA oxidation
- Niacin, zinc and folate in DNA repair
- Suggestive of a positive role of the Mediterranean Diet
335
What is healthy ageing?
- As the process of developing and maintaining the functional ability that enables wellbeing in older age”
- Focus on a healthy life span rather than increasing life expectancy: no point someone living until 100 if they develop severe chronic diseases by 50
336
What is the effect of losing a partner in old age?
→ Females may have greater nutrition knowledge and cooking skills
→ Men may lack these skills, either develop skills or rely on ready made foods
- If male passes away, women change cooking style and either give up cooking or cook less and less nutritional meals
- If female passes away, men lack these skills and rely on ready-made products
- Eating alone: known to decrease intake and quality of food consumed
- Potential for social isolation: loss of quality of life, increased depression
337
What are individual factors of food security?
- Disability, perceived disability, chronic illness
- Carry or lift groceries
- Female
- Low socioeconomic status or of a different cultural background
338
What are social factors of food security?
- Living alone
- Lack of supportive network
- Reluctance in accepting help from external providers
339
What are macro level factors of food security?
- Financial support
- Appropriateness of emergency food relief
339
What are physical factors of food security?
- Renting
- Living rurally/ food deserts
- Lack of access to public transport or private transport
340
What are community based HCP?
- Centre-based day respite
- Care, company and group activities in the centre, and may include short trips away from the centre
- Transport (day centre, shopping & appointments)
- Social support (shopping, banking, appointments, just a chat)
341
What are home based HCP?
- Domestic assistance (cleaning, clothes washing and ironing)
- Personal care (bathing or showering, dressing, hair care and toileting)
- Home maintenance (General repair and care of a client's house or yard)
- Home modification (install safety aids like alarms, ramps and support rails)
- Community nursing (provided by a qualified nurse)
- Food services (provide meals, help with shopping, preparing & sorting food, delivering meals to the home)
- Respite Care
- Support Services for carers
342
What is Beehive Industries ?
- Low Cost for Seniors Meal Program
- Noticed the older people always ate a large breakfast
- Identified that most were not eating a substantial dinner meal
- Designed a cooking school that increases cooking skills using low cost ingredients
- Simple language
- Every recipe takes less than 20 minutes
- Uses readily available foods
342
What is Let’s Do Lunch: Meals on Wheels ?
- Targeting social isolation and loneliness in older adults and increase connection to community and deliver care into homes
- Intervention: Volunteers have lunch with clients every 3 weeks
- Volunteers trained to assess client wellbeing
342
What is the political space of aged care?
- Fund a 15% pay increase for aged care workers
- Improve provider regulation through a new regulatory model
- Improve access to high quality aged care
- New Aged Care Act legislated 12/09/24
- Unfortunately, staff in food services did not receive the same pay increase
342
What is Live Up Australia (issues being able to open jars, etc)?
- Not-for-profit that is funded by the Australian Government
- Social events and booklets to make cooking easier
- Provide information on
→ Exercise classes
→ Product suggestions
→ Local groups to engage with
342
What is the Royal commission into residential aged care in Australia?
- Failed to meet nutritional needs
- Poor quality and unappetising food
- Many people becoming dehydrated and malnourished
- Lack of assistance to eat and drink
343
What is nutrition in aged care like?
- Potentially unappetising foods
- Lack of choice in foods: lack of flexibility
- Rigid mealtimes: lunch is the biggest meal of the day
- Unappealing texture modified foods
- Limited staff to assist residents with eating (cutting up food, feeding residents)
- Sole source of food for many residents: important to get it right
- Healthy Eating guidelines don’t apply to the frail elderly. Limiting salt and sugar in this group in unnecessary and can do more harm than good
344
What would increasing choice in resident aged care do?
- Having various meals to impact nutrition and quality of life
- Brings enjoyment back to meal time
- Increases food consumption, satisfaction, protein/veg, decrease in carbs
- Increased cost but only very minor
- Reduced wastage
345
What would increasing choice in resident aged care change for residents?
- Empowered residents
- Excited for meals
- Like a restaurant
- Allows preferences
- Gives autonomy
346
What would increasing choice in resident aged care change for staff?
- Dining room became a place of conversation
- Happier residents: less complaints
347
How would increasing choice in resident aged care help dementia patients?
- Use AI to assist people to communicate their preferences with food
- Uses images and ideas
- Allows different ways of communication
- Design a meal they like or a memory they enjoy with AI to explore preferences to design a menu that suits their preferences/needs
348
What is the GOAL for older adults?
GOAL = ensure that older people can fulfil their potential in dignity and equality and in a healthy environment.
- Integrated care
- Long term care
- Combatting ageism
- Age friendly environments
349
What do we need to remember about older adults?
- Older people are more than their age or illness
- They bring a lifetime of knowledge & experiences
- View strengths rather than weaknesses
- Don’t fear being old
- They are the creators, pioneers, change drivers and supports of our community
