Post-Midterm Material Flashcards
(181 cards)
1
Q
Define adulthood
A
- Physiology most stable period of life
- Gradual changes in body weight, compostion, metabolism, hormones, and senses with aging
- Prevention of chronic disease and healthy aging may become priorities
2
Q
What are the nutrition goals for adults?
A
- Maintence of body weight, compoosition, and bone health
- Optimal health for activites of daily living and sports
- Prevention of chronic disease
- Setting up for healthy aging
3
Q
What happens to metabolism in adulthood?
A
After age 20 years, basal metabolic rate decreases
4
Q
What happens to body weight in adulthood?
A
Body weight tends to increase over time, then decreases with advanced age
5
Q
What happens to body composition in adulthood?
A
% body fat tends to increase with age, starts to drop off with older age
* ↓ Lean mass and ↑ in fat mass
* Muscle strength declines with age - Use it or lose it
Muscle doesn’t re-generate with age
6
Q
What is a hormal change in adulthood?
A
Menopause
7
Q
What is menopause?
A
- Ovulation ceases, estrogen and progesterone levels fall
- Occurs between 45-55 y (but peri-menopause starts much earlier)
- Signs: hotflashes, mood swings, night sweats
- Body composition changes: fat tends to redistribute to abdominal regions
Fat distributes from hip to stomach
8
Q
What does combining BMI and waist circumference describe?
A
BMI
* easy measure and is proxy measurement of fat but not accurate
* better indicators are diet, lifestyle, physical activity and bloodwork
Waist Circumference
* Best indicator of visceral fat
9
Q
With regards to chronic disease risk, is it better to be obese
and fit or lean and unfit?
A. Lean and unfit
B. Obese and fit
C. Both are associated with the same risk
A
B. Obese and fit
10
Q
What is the skeleton composition in adulthood?
A
- Total body bone mass peaks in mid-30s (but specific sites peak much ealier)
- Gradual loss thereafter
- Rapis loss in females during 3-5 years around menopause
11
Q
What are senses changes in adulthood?
A
After age 40, taste, smell, vision, and hearing begin to decrease
Gradual, unrecognized
Potential issues:
* Decreased appetite and energy consumption
* Increased use of sodium based flavorings
12
Q
What are the age categories of dietary reference intakes?
A
- 19-30 yrs
- 31-50 yrs
- 51-70 yrs
13
Q
Based on the physiological changes of adulthood, what do you predict would be key nutrients of concern?
A
- Calcium/vit.D
- B12
- Protein
- Energy - B vitamins
14
Q
What is the only nutrient different within age categories 19-30 yrs and 31-50 yrs?
A
Magnesium
15
Q
All other things equal, how much does EER decrease per year for
inactive males and females?
Male
EER = 753.07 – (10.83 × age) + (6.50 × height) + (14.10 × weight)
Female
EER = 584.90 – (7.01 × age) + (5.72 × height) + (11.71 × weight)
A. We cannot answer this from the information provided
B. Approximately 20 kcal for men and 3 kcal for women
C. Approximately 11 kcal for men and 7 kcal for women
D. None of the above are true
A
C. Approximately 11 kcal for men and 7 kcal for women
16
Q
Which group below has the highest RDA for Calcium?
A. Adolescents 14-18 y
B. Young adults in their 20-30s
C. Adults in their 40-50’s
D. Older women (over age 50)
A
A. Adolescents 14-18 y
17
Q
What is the government of Canada guideline for vitamin D?
A
You can get vitamin D from:
* Sun
* Food
* Supplements
Includes vitamin D from foods or a supplement every day
If you are between 2 and 50 yrs:
* eat foods that contain vitamin D every day or
* take a daily supplement containing 400 IU (10 ug) of vitamin D
If you are 51 yrs of age and older:
* take a daily supplement contianing 400 IU (10 ug) of vitamin D
* you can continue to eat foods that contain vitamin D as part of healthy eating
18
Q
What are the RDA of iron for each age category?
A
Male
* 14-18 yrs: 11 mg
* 19-50 yrs: 8 mg
* >50 yrs: 8 mg
Female
* 14-18 yrs: 15 mg
* 19-50 yrs: 18 mg
* >50 yrs: 8 mg
* Pregnancy 19+: 27 mg
* Lactation 19+: 8 mg
19
Q
What is the RDA of vitamin B12 for adults?
A
2.4 ug/day
20
Q
Why is vitamin B12 recommended after age 50?
A
A synthetic source (supplement or fortified food)
Low gastric acidity in 10-30% of adults over age 50 yrs decreases the release of protein-bound B12 from food
21
Q
With inadequate intakes, symptoms of low B12 are likely to manifest within …
A. A few days
B. A few weeks
C. A few months
D. A few years
E. Never, B12 symptoms are hidden
A
D. A few years
22
Q
What are the Al of fibre based on reducing risk of heart disease?
A
Men:
* 19-50: 38 g/d
* 51+: 30 g/d
Women:
* 19-50: 25 g/d
* 51+: 21 g/d
23
Q
Do Canadians get enough fibre?
A
Most Canadian adults get MUCH less fibre than the Al
24
Q
From nutrient intakes of Canadian adults, what are the nutrient high prevalence of inadequate intake?
A
- Vitamin A
- Vitamin D
- Vitamin C
- Magnesium
- Calcium
- Fibre
- Potassium
25
From nutrient intakes of Canadian adults, what are the nutrient excess intake?
Sodium
26
To improve intakes of nutrient listed as inadequate, Canadians adults should consume more?
Fruits and vegetables (dark green, orange)
* Vitamin A, Vitamin C, Potassium, Fibre
Dairy, fortified milks
* calcium, vitamin D
Whole grains
* Fibre, magnesium
27
To improve intakes of nutrient listed as excess, Canadians adults should consume less?
Avoid highly processed foods
28
What is the main nutrient missing from the Canada's Food Guide?
Calcium
29
Beyond food, What are health advice for adults?
* Physical activity
* Alcohol
* Supplements
30
What is a healthy 24 hours includes for an adult?
Sleep:
* 7 to 9 hours of good-quality sleep regularly
* Consistent bed and wake-up times, even on weekends
* Helps with memory, mood, and overall health
Physical Activity
* At least 150 minutes/week of moderate-to-vigorous aerobic activity (e.g. brisk walking, cycling)
* Ideally in abouts of 10+ minutes
* Muscle strengthening activities 2 or more days/week
* Target major muscle groups (e.g. legs, arms, core)
* Several hours of light physical activity (e.g. standing, chores, walking)
Sedentary Behaviour
* Limit sedentary time, especially recreational screen time
* <3 hours/day of screen use recommended
* Break up long periods of sitting as often as possible
* Stand, stretch, or walk every 30–60 minutes
31
What is the canada's guidance on alcohol and health?
* 0 drinks per week: better health and better sleep
* 1 to 2 standard drinks per week: likely avoid alcohol-related consequences for yourself and others
* more drinks per week: more health risks
32
What are risks of alcohol?
* Cancer
* Heart disease
* Liver disease
* Violence
33
Other than vitamin D and B12 for adults over 50, should adults regularly take supplements to ensure optimal health and prevention of chronic disease?
A. Yes
B. No
B. No
34
What is the general recommendation when it comes to foods vs supplements?
1. Foods first
2. Fortified foods
3. Supplements
35
Justify this recommendation using what you know about the safety of foods vs. supplements
* Excess
* Food have multple nutrient
36
What are the goals of nutrition in adolescence?
* Nutrients and energy to support rapid growth and maintenance of nearly adult sized bodies
* Independence in food choices and food skills
37
Which is the most accurate definition of adolescence?
A. Age 13 - 19
B. Onset of puberty to age 19
C. Onset of puberty until physical maturity is reached
D. Onset of puberty until physical, psychosocial, and cognitive maturity are reached
D. Onset of puberty until physical, psychosocial, and cognitive maturity are reached
38
What is adolescence?
Period of transition between childhood and adulthood
39
What happens in adolescence?
* Begins with the onset of physiologically normal puberty and ends when adult identity and behaviour are accepted
* Typically ~10-19 yrs but better to use biological and psychosocial indicators rather than ages
* Major changes physical and psychosocial changes
40
What are biological changes in adolescence?
* Gain height, weight
* Build bone mass
* Changes in body composition
* Sexual maturation
* Variable timeline
41
What are psychosocial changes in adolescence?
* Struggle for independence
* Social roles
* Relationships with peers
* Adolescent turmoil is normal!
42
What is puberty?
* Changes that transform child’s body into adult body
* A lot of variation in age of onset & rate of progression
Sexual maturation includes:
* Development of pubic hair
* Breast and genitalia development
* Menarche (mean age in North America: 12.5 years)
43
What is growth & in Women
Height Spurt: 9.5-14.5
Menarche: 10.5-16.5
Breat: begins - 8-13; fully - 13-18
Public hair: 10-15
44
What is growth & development in Male?
Height spurt: 10.5-16; 13.5-17.5
Penis: 10.5-16.5
Testes: 9.5-17.0
Public hair: 11-16
45
What is the adolescent growth spurt?
Growth spurts:
* Girls typically peak velocity ~ age 12
(between SMR stage 2 & 3)
* Boys typically peak velocity at age ~14
Linear growth usually complete at ~16 (girls) and ~18 (boys)
46
Describe the growth spurt for adolescence
Growth Spurt
- Increased hunger and food intake
- Body fat gain
- Height gain and body fat loss
Growth plateau
- Decreased hunger and food intake
Growth spurt
- Sequence repeats at start of next growth spurt
47
What is the body composition in adolescence?
* Muscle growth accelerates in both sexes
* Males gain ~twice as much muscle as females
* Females - body fat ↑ to ~23%
* Males - body fat ↓ to ~12%
* Girls - estrogen affects cartilage in the hip joint
* Boys - testosterone affects cartilage in the shoulder joint
48
What is the bone mass in adolescence?
* Rapid bone mass accumulation
* ~half of total bone mass is accrued during adolecence
49
Rapid increase in bone mass will lead to higher requirements for:
A. Calcium only
B. Calcium & phosphorous
C. Calcium, phosphorous & vitamin D
D. Calcium, phosphorous & magnesium
E. Calcium, phosphorous, magnesium & vitamin D
D. Calcium, phosphorous & magnesium
50
What are two age groups for DRI categoris for adolescents?
Two age groups:
* 9-13 years
* 14-18 years
* Separate recommendations for males and females - based on biological sex not gender
DRI generally based on chronological age not growth/sexual maturity
Many micronutrient needs reach adult levels by age 14
* Some are higher than adult needs
51
Energy requirements are higher for males. Why might this be?
A. Males are more active
B. Males have higher growth rates
C. Males have more lean mass
D. Males have bigger appetites
C. Males have more lean mass
52
What is the energy requirements for adolescents?
* Peak requirements for growth and maintenance of almost fully- grown body
* Large variability in growth ⇒ confirm energy intakes with growth
53
What is the AMDR % energy for adolescent?
CHO: 45-65%
PRO: 10-30%
FAT: 25-35%
54
Which nutrient needs increase in adolescence?
Calcium, Phosphorous, Magnesium
* Iron stores are meant to be full
55
Total recommended protein intakes (g/d) are generally higher
for children compared to adolescents.
A. True
B. False
B. False
56
Jane is a healthy 12-year old female who has recently started menstruating. What would be her recommended iron intake?
A. 8 mg/d
B. 11 mg/d
C. 15 mg/d
D. 18 mg/d
C. 15 mg/d
57
What are developmental tasks during adolescence?
1. Independence
2. Body image
3. Peer relations
4. Identity (sense of self, valuess, social responsibility)
58
What are the common eating behaviours in adolescence?
* Eating away from the home
* Snacking (25% of calcories comes from snacks)
* Meal skipping (especially breakfast)
59
What is the cognitive development in adolescence?
Abstract thinking capabilities develop during late adolescence – before this, adolescents have difficulty understanding the perspectives of others and perceiving how current behaviors might influence future health
60
In Canada, compared to younger children, does the overall dietary quality of adolescents:
A. Improve
B. Decrease (get worse)
C. Stay about the same
B. Decrease (get worse)
61
What are the prevalence of inadequacy of nutrients with an EAR in Canadian adolescents aged 9-18 y?
Calcium, Magnesium, Phosphorous, Vitamin C, Vitamin D
62
What is the iron RDA in adolsescence?
Ages 14-18
Male: 11 mg/d
Females: 15 mg/d
Iron deficiency anemia not common but many teens may have **reduced iron stores**
63
What are adolescent risk factors for iron deficiency?
heavy menstruation, vegetarian diet, endurance athletes, disordered eating, low socioeconomic status, lack of balances diet, inadequate nutritional intake
64
Do generally healthy adolescents with a varied diet require a vitamin/mineral supplement?
A. Yes
B. No
B. No.
65
What is the incidence of eating disorders in Canadian children in comparision to type 2 diabetes?
A. 2-4 times less than type 2 diabetes
B. They have the same incidence
C. 2-4 times more than type 2 diabetes
C. 2-4 times more than type 2 diabetes
66
What are types of eating disorders?
Anorexia Nervosa
Bulima Nervosa
Binge Eating Disorder
Avoidant/Restrictive Food Intake Disorder
Other specified feeding or eating disorder
- "Atypical" Anorexia
- Purging Disorder
- Night Eating Syndrome
67
What is anorexia nervosa?
o Restricting intake leading to significantly low body weight
o Fear of weight gain
o Disturbance in how body is experienced
Subtypes:
o Restricting
o Binge/Purge
68
What is bulimia nervosa?
o Recurrent restriction followed by binge eating
o Recurrent compensatory behaviors: self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
69
What is binge eating disorder?
o Recurrent binge eating without recurrent compensatory behaviours
70
What is a disordered eating?
o Sits on a spectrum between body and food acceptance, and eating disorders
May include symptoms and behaviours of eating disorders, but at a lower frequency or level of severity
o Restrictive eating/dieting
o Compulsive eating
o Irregular or inflexible eating patterns
71
Why does disordered eating matter?
o Disordered eating behaviours (especially dieting) are among the most common risk factors for the development of an eating disorder
o When the body is starved of food it responds by reducing the rate at which it burns energy (the metabolic rate) and this can result in rebound eating and binge eating behaviour
o Dieting is also associated with other mental health concerns including depression and anxiety
72
What are predisposing factors of eating disorder?
**SOCIOCULTURAL**: media, social media, thin ideals, anti-fat bias
**FAMILY**: conflict, divorce, death, dieting/modeling, genetics
**INDIVIDUAL**: perfectionism, poor emotional regulation, trauma
**PERPETUATED**: belief systems, control, body image, validation, emotional regulation, helps meet other unmet needs
73
What are nutrition interventions for eating disorders?
* Correct nutrient deficiencies, and re-nourish
* Weight restoration and stabilization
* Normalize eating behaviours
* Nutrition education
74
What are correct nutrient dificiences, and re-nouish for eating disorders?
o Intravenous fluids
o Vitamin and mineral (electrolyte) supplementation
o Enteral nutrition, and/or
Meal plans:
o Eating regularly ~ every 2-3 hours
o Include all food categories
o Adjusted to help with medical stability and meet energy needs
75
What is weight restoration?
o below a BMI of 20
o higher risk of morbidity and mortality
o impaired ability to do psychological and cognitive work
76
What is weight stabilization?
o BMI of 20 and beyond
o focus on health promoting behaviours
o allow the individual to establish their “natural” weight
77
What are factors of natural weight?
* Genetically determined like eye colour or height
* Stable bloodwork
* Return of menses
* Absence of eating disorder behaviours
* Body resists dramatic changes to weight
* Hunger is honoured
* Food freedom/flexibility
* Decreased obsessions about food and body
78
What is mechanical eating?
o Meeting nutrition needs
o Increasing variety
o Re-learning hunger and fullness cues
o Exploring emotions and food
o Reducing use of eating disorder behaviours
79
What is intuitive eating?
* Reject diet culture
* Honour your hunger
* Make peace with food
* Discover the satisfaction factor
* Feel your fullness
* Challenge the food police
* Cope with your emotions with kindness
* Respect your body
* Movement – feel the difference
* Honour your health – gentle nutrition
80
What are some "do's and don't's" for eating disorders?
o Do emphasize that all foods fit
o Do refrain from using language that labels food
o Do not emphasize that exercise needs to occur to “burn off calories”– especially after certain types of foods are consumed
o Do not make disparaging remarks regarding anyone’s body (including your own!)
o Do not encourage weight loss or offer celebration or praise after someone has lost weigh
81
Food insecurity is most prevalent among:
A. Elderly females living alone
B.Single parents households
C. Households with >3 children
D. Elderly males living alone
B.Single parents households
82
What are programs and services for seniors in Canada?
Canada Pension Plan Retirement pension
Old Age Security
Guaranteed Income Supplement
83
What proportion of health spending in Canada was spent
on seniors (>65)?
A. <10%
B. ~15-20%
C. ~25-30%
D. ~45-50%
E. ~65-70%
D. ~45-50%
84
What are the nutrition and lifestyle for older adults/aging?
Increase longevity
Promote healthy aging
85
What is definition of "older adults"?
* DRI: 51-70, 70+
* Seniors = typically about 65 y+
* Chronological age vs functional age
86
What are key concerns of aging?
* **Physiological changes** associated with aging
* Increased likelihood of **chronic health conditions and medications**
* **Psychosocial** changes: retirement, loss of friends/partners, loss of independence
* But note: **significant variability** in living conditions and health, income
87
What are nutrition goals of aging?
* Sufficient energy, nutrients and protein to **support muscle and bone mass and healthy aging**
* **Independence or support** to access nutritionally appropriate and acceptable foods
* Consider nutritional needs for **management of health conditions** and medication interactions
88
What are physiological changes with aging?
Variable changes in
1. Sensory perception
2. Oral health & gastrointestinal function
3. Organ function
4. Body composition, including muscle and bone density
5. Chronic disease
89
What are sensory changes with aging?
**Taste & Smell**
* Number of taste buds decline with age
* Salivary secretions decrease
*** Xerostomia**: dry mouth, due to decreased saliva production
* Smell decreases = reduced flavor perception
**Sight**
* Presbyopia (farsightedness)
* Glaucoma and cataracts
90
Which of the following is correct?
A. Glaucoma is caused by damaged proteins on the lens of the eye
B. Glaucoma is caused by damage to the optic nerve
C. Cataracts are caused by protein accumulation on the cornea
D. Glaucoma is reversible with surgery
E. Cataracts are irreversible and irreparable
A. CATARACTS is caused by damaged proteins on the lens of the eye
B. Glaucoma is caused by damage to the optic nerve - CORRECT
C. Cataracts are caused by protein DAMAGE on the LENS
D. Glaucoma is IRREVERSIBLE with surgery
E. Cataracts are REPARADE
91
What are the gastrointestinal funcion: teeth with aging?
* Periodontal disease
* Gum disease: can lead to tooth loss (due to degradation of tissue around teeth)
* Oral health improving; until recently, 50% lost teeth by age 65
* Dentures often don’t fit well
92
What are the gastrointestinal funcion: esophagus with aging?
* **Dysphagia**: difficulty in swallowing foods
* May cause pain and regurgitation
* Eat in upright position, emphasize fluids
93
What are the gastrointestinal funcion: stomach with aging?
**Slower gastric emptying**
* Gastric emptying half-time is ~50 min in young adults (~26 y) vs ~120 min in older adults (~77 y)
* Smaller, more frequent meals may help
**Gastric atrophy**
* Stomach muscles and glands shrink and become weak
* Decreased acid, pepsinogen and intrinsic factor secretion
* Implications for protein digestion, mineral absorption, B12 absorption
94
What are the gastrointestinal funcion: large intestine with aging?
Constipation from decreased smooth muscle tone and
* Low fluid intake
* Diet low in bulk and fibre
* Medications
* Lack of exercise
95
What are recommendations for prevention of constipation?
1. Whole grains
2. Vegetables and fruits
3. Limit processed and high-fat foods
4. Dried fruits or prune juice
5. Drink plenty of fluids
6. Walk every day
7. Limit use of antacids
8. Develop regular bowel habits
96
What are changes in organ function: kidney with age?
* Decreased renal blood flow
* Less adaptable to changes in fluid, sodium
* Reduced ability to concentrate wastes
97
What are changes in organ function: liver with age?
* Function decreases
* Less efficient at breaking down drugs and alcohol
98
What are changes in connective tissue with age?
Blood vessels & skin
* Less pliable, reduced elasticity & collagen
99
On average, how does vitamin D production of a 75-year-old compare to that of 25-year old, when exposed to the same amount of sunlight?
A. About the same
B. 2x higher in 75 year old
C. 4x higher in 75 year old
D. 2x less in 75 year old
E. 4x less in 75 year old
E. 4x less in 75 year old
~400 IU vitamin D after the age 50
100
What are hormone changes with age?
In males, **testosterone** begins to decline at ~ 40 y
In females, **menopause** – cessation of menstruation occurs ~45-55 y
* But **perimenopause** can begin years before
* Significant drop in **estrogen** and **progesterone** after menopause
* Symptoms: hot flashes and night sweats, headaches, irritability, volatile emotions, reduced ability to concentrate
101
What is the affect of menopause with age?
* Decrease in basal metabolism
* Increased hunger
* ↑ Visceral fat
* Altered metabolism causing chronic inflammation
* Decreased thirst and altered fluid balance
* Higher risk of CVD, cancers, insulin resistance
102
What are metabolism and body composition changes with age?
Total and basal energy expenditure declines
* Initially, ↑ body weight and fat mass through adulthood
In later adulthood (>65y)
* Declines in body mass
* Fat mass
* Lean mass (muscle & bone)*
103
What is scaropenia?
* Decline of skeletal muscle tissue with age
➢ Reduced anabolism and hormones
* Contributes to functional decline, frailty, falls and loss of independence
104
What are multifactorial cause including nutrition with sarcopenia?
* Low protein & energy intake
* Micronutrient deficiency
* Malabsorption and other gastrointestinal conditions
* Decreased appetite
105
What is osteoporosis?
* Osteoporotic bone is thinner, more porous, and weaker than healthy bone
* Leading cause of hip and spine fracture among older adults
* 28% of women and 37% of men who have a hip fracture die within one year
106
What is dowager's hump?
aka “hyperkyphosis”
= forward curvature of the spine, caused by collapse of front edges of thoracic vertebrae
107
What is trabecular bone fractures?
* Trabecular (spongy) bone is more sensitive to changes in hormones and nutritional factors
* Higher rate of fracture in regions with greater proportion of trabecular bone
108
How is osteoporosis diagnosed?
A. Dietary intake
B. Blood calcium
C. Symptoms
D. Incidence of falls or broken bones
E. Bone density
E. Bone density
109
Should all older adults take calcium and vitamin D
supplements to prevent osteoporosis?
A. Yes to both
B. Yes to calcium, no to vitamin D
C. No to calcium, yes to vitamin D
D. No to both – adequate amounts can be obtained from food
C. No to calcium, yes to vitamin D
110
What are psychosocial changes with aging?
Adjusting to:
* decreased strength and health
* retirement and lower income
* death of partner/friends
* affiliation with age group
Establishing satisfactory living arrangements
Less independence?
- choose to age in place
Large variability in health, income, living arrangements, social network
111
How might the physiological changes in aging affect nutrient requirments, preferences, and food intakes?
* Atrophic gastritis - vit B12 absorption; increase pH - protein digestion
* Decrease oral health - chew and shallow; reduced tase/smell - less desire to eat
* Reduced vitamin D syntheisi - increase vitamin D requirements
* Sphincter decrease - acid reflux
* Chronic disease - nutrient requirements; medicatin
* RIsk of sacropenia and osteoporosis - increase need for protein, Ca, Vtiamin D
* Slower gastric motility - smaller meal
* Constipation - fibre
* Decrease elasticity of arteries and decrease renal fucntion - Na and K
112
What is energy reqirements with aging?
Same **EER equation** as for adults 19+
Decreased energy needs:
* Lower **activity** levels
* Decrease in **basal metabolic rate**
Energy requirements of sedentary, older adults may be quite low
- Makes meeting nutrient needs harder
Example:
* 85-yr-old sedentary female, 1.55 m in height,
* BMI = 24.9, EER < 1500 kcal
113
The RDA for protein in g/kg/d for those over 70:
A. Is higher compared to younger adults
B. Is lower compared to younger adults
C. Does not change with aging
C. Does not change with aging
114
What are fluid intake Al with aging?
* AI for water: 3.7 L/d males, 2.7 L/d females
Includes drinking water, water in beverages, water in food
* No change from 19+
115
Why are older adults are prone to dehydration?
1. Reduced total body water
2. Reduced ability to concentrate urine = ↑ fluid lost
3. Reduced perceived thirst = ↓ intake
Risk increases with heat or exercise
116
What are the precentage of body made up of water?
Infant: 70%
Adolescence: 60%
Adult: 50%
Older adults: 50%
117
What is fibre intake with adulting?
AI: 14 g/1000 kcal
* No change from 19+
* Slight decrease in total needs with aging due to ↓ calories
Fibre important for:
- preventing constipation ↓ LDL cholesterol → ↓ risk of CVD
118
What is vitamin D intake with aging?
Lower circulating vitamin D levels
* less sun exposure
* reduced skin vitamin D synthesis
* reduced hydroxylation (activation of vitamin D in liver & kidney)
RDA
* 15 mcg (600 IU) for age 50-70
* 20 mcg (800 IU) 71+
Health Canada recommends a supplement
(**400 IU per day beginning at age 50**)
119
What is calcium intake with aging?
RDA increases
* 19-50 y 1000 mg/d
* Females > 50: 1200 mg/d
* Males >70 y: 1200 mg/d
Females are earlier because of menopause - Bone health
120
How many cups (250 ml) of milk need to be consumed to
reach 1200 mg calcium?
~ 4 cup
121
How is vitamin B12 absorption with aging?
* Food sourced-B12 is bound to proteins
* **Acid** & enzymes needed to free B12
* B12 binds to **intrinsic** factor in intestine for absorption
* Aging = ↑ **atrophic gastritis** - medication
* Loss of stomach lining impairs secretion of **acid & intrinsic factor**
122
What cells secrete acid and intrinsic factor?
A. Parietal cells
B. Chief cells
C. Mucus cells
D. Enteroendocrine cells
E. Gastrochloric cells
A. Parietal cells
123
What is the RDA of vitmain B12 for adults and older adults?
RDA for adults 19+: **2.4 ug/day**
Because 10 to 30 percent of older people may be unable to absorb
naturally occurring vitamin B12, **it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a vitamin B12-containing supplement.**
124
From Yvonne Lamers paper, what is vitamin B12 requirements in older adults in Canada?
Dietary B12 intake of 6-10 ug/day from mostly natural food sources allows older adults to acheive [adequate B12]
* Dairy is a main contributor of B12 intakes (also riboflavin, vit D, calcium)
* In Canada, mandatory fortification with B12 only applies to simulated meat and egg products, not plant-based beverages
* “With dairy being a key contributor to B12 status, especially in older adults, it is critical that dairy alternatives are fortified with B12 given the contribution of dairy to total B12 intake and status, and especially in individuals not consuming any other animal source foods such as fish"
125
What are important to be consume sufficiently for older adults?
* Protein to retain lean mass
* Calcium & vitamin D for bone
* Fluid & fibre
126
What are the healthy eating for seniors from the Canada's food guide?
Enjoy a variety of healthy foods
* Fruit and veg, whole grains, protein foods
* If you are 51 years of age or older, take a supplement with 400 IU (10 μg) of vitamin D every day.
* Drink water
* Shopping or cooking for 1 or 2
* Eat with others
* Create an emergency food supply
* Check out resources in your community
127
Why is food safety in older adults important?
* Foodborne illnesses more likely due to **limited vision**, decreased sense of **smell, forgetfulness** combined with **compromised immune system**
128
What are prevalence of inadequate nutrient intake aged 65 y and older from only foods?
Folate, Zinc, Protein, Vitamin B12, Iron
129
What are benefits and risks of calcium supplements for prevention of osteoporosis?
Potential Benefits:
* ↓ Fractures
* ↓Osetoporosis
* Possible protection against cancer ← CVD
Potential risks:
* ↑ Constipation
* Kidney stones
* ↑ Risk of CVD
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If an older adult has gallbladder disease, you might be
more concerned with absorption of:
A. Vitamin C
B. Vitamin B12
C. Folate
D. Minerals
E. Fat soluble vitamins
E. Fat soluble vitamins
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An older adult on diuretics might have very low:
A. Sodium
B. Potassium
C. Vitamin D
D. Iron
E. Fat soluble vitamins
B. Potassium
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What are factors influencing nutrient requirements of older adults?
* Physiological changes and rate of aging
* Health and Chronic disease
* Medication use
Medications can influence nutrient
* Ingestion
* Digestion/absorption
* Utilization - displace nutrient on protein
133
What are childhood stages ages?
* Toddlers (12 – 36 months)
* Preschoolers (3 – 5 years)
* School-aged children (6-12, or onset of puberty)
134
What are the 3 DRI age groups?
* 1-3 y
* 4-8 y
* 9-13 y
135
What are goals for childhood nutrition?
1. Adequate intake of energy and nutrients to support growth and maintenance of body
2. Development of feeding skills
3. Establishing a “good relationship” with food
4. Eating socialization
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What are growth & development for toddlers?
Continued **growth and development**
- Will grow ~1 cm and 0.23 kg/month
- Still have relatively small stomach
* Develops teeth
* Gross and fine motor coordination
* Increasingly **independent**, can express likes and dislikes
* **Personality** continues to emerge
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What are feeding skills for toddlers?
* By 1 yr, should be eating a variety of family foods
Still at risk for choking
* Avoid hard candy, popcorn, nuts, whole grapes, and foods cut into rounds
By 2 yrs, become reasonably proficient at self-feeding
* use of spoon
* use of a cup
138
What is appetite & portion sizes?
Portions offered to child at start of meal should be ~1 Tbsp
for each year of age
- 2 Tbsp of each for a 2 year old
Small stomachs require snacks between meals
139
When should weaning from the breast occur?
A. At 12 months
B. At 6 months
C. At 12-18 months
D. At 24 months
E. Whenever the child or parent is ready
E. Whenever the child or parent is ready
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What are growth & development for preschoolers?
Growth rate slows
* Appetite may decrease
Increased **autonomy**
Increased language, decision-making skills
Expanded motor skills: Can ride tricycle/run bike, throw ball, jump on one foot
Broader social connections
141
What are feeding behaviours for preschoolers?
More developed motor skills: Can use cup, spoon, fork
Growth occurs in spurts = appetite can be variable
* Influenced by parents, siblings, peers
* Excellent opportunity to teach children about food selection and preparation
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Janey takes two bites of food and says she is “done!”. How should her caregiver respond?
A. Ask Janey to eat just one more bite
B. Encourage Janey to finish her plate
C. Allow Janey to choose how much to eat
C. Allow Janey to choose how much to eat - DoR
143
What are growth & development for school-aged children?
* Still growing
* Latter portion: sexual maturation starts
* Increasingly independent
* Physical activity more variable
144
What are feeding behaviours for school-aged children?
* Spend more time at school, with friends – eating more often without
parental supervision
* Peer relationships become more important
* More susceptible to **advertising**
* Important to model good feeding behaviors **through family meals**
145
What would be considered “healthy drink choices” for
children? [Select all that apply]
A. Water
B. Whole (3.25%) milk
C. Fortified soy beverages
D. 100% fruit juice
E. Fruit punch
A. Water
B. Whole (3.25%) milk - introduce: 9-10 months & whole to 2 yrs
C. Fortified soy beverages - after 2 yrs, decrease calcium and protein
D. 100% fruit juice - vitmains, shouldn't diplace other drinks
146
What is the division of responsibility in feeding for parents and children?
Parents are responsible for: What, Where, When
Parents feeding jobs:
- Choose and prepre the food
- Provide regular meals and and snacks
- Show children bu example how to behave at family mealtime
- Be considerate of children's lack of food experience without catering to dislike and likes
Children are responsible for: How much and whether
Children feeding jobs:
- Children will eat
- They will eat the amount they need
- They will learn to eat the food their parents wat
- They will grow predictably
- They will learn to behae well at mealtime
147
What happens if children are given a pre-meal drink?
Low energy (aspartame) -> consume more energy at lunch
High energy (sucrose) -> consume less energy at lunch
148
What happens if adults interfere with food intake?
- self regulation disappears
- Young children have an innate ability to control energy intake, when parents interfere decreases innate ability
149
According to the photos on the previous slide, infants have an innate preference for: [Select all that apply}
A. Sweet
B. Sour
C. Bitter
D. Salty
E. None of these
A. Sweet
D. Salty
150
What are food preferences for children?
* Innate preference for: sweet and salty
* Prefer familiar foods
* Comfort
* Control
Prefer foods individually not mixed
* Tend to not like strongly flavored foods, spicy foods
151
What are food influences in childhood?
* Familiarity – can take **10-20+ times** to accept a new food
* Family
Food context
* Foods used as rewards or “special treats” become more enticing
* Foods forced gain negative association
152
What are the four themes in nuturing children's healthy eating?
Four Themes:
1. **Parental feeding practices** for building and shaping
healthy eating habits
2. **Eating together** as a key element of health
promotion in children
3. A **positive home food environment** encouraging
healthy eating practices
4. The **pleasure** of eating
153
What are the three parental feeding practices?
1. **Authoritartive**: some rules/limits with sensitivity towards the child's needs
2. **Authoritarian**: highly controlling/restrictive
3. **Permissive**: provide little structure and allow children to eat whatever they want
154
Which parenting style is associated with most healthy eating habits in children?
A. Authoritative
B. Authoritarian
C. Permissive
D. Parenting style does not influence child eating habits
A. Authoritative
155
“I don’t like it”
According to her parents, Jessica doesn’t like broccoli. Her parents know it is good for her and they encourage her to eat it. They have several rules for dinner time, including that Jessica needs to eat half of her vegetables before she is allowed to leave the table.
What advice would you provide to Jessica’s parents?
"encourage her to eat it" - pressure
- serve and offer
- model eating
- don't make rules - child chooses whether and how much
156
What if the child says "I just want dessert"? Reasoning and solution
* Dessert is often used as a **‘reward**’ by parents (“You have to finish your peas before you can have dessert”)
* Research shows **“bribing”** child with dessert increases liking of dessert and decreases liking of the food they need to eat to get dessert (e.g., vegetables)!
Solution: present all meals at once, so dessert isn't seemed a special moment during dinner
157
What are strategies for fostering healthy
* Division of responsibility
* Encourage appetite
* Feed small meals and snacks at consistent time.
* Let them get hungry
* Offer drinks at the end so they have room to eat
* Avoid distractions
* Eat as a family and be a role model
* Avoid bribes, pressure, using food
as rewards/punishments
158
Explain the importance of the Canadian 24-Hour Movement Guidelines for the Children and Youth (5-17 years)?
**1. Physical Activity**
* At least 60 minutes per day of moderate to vigorous physical activity (e.g., biking, running, swimming).
* Most of it should be aerobic.
* Include vigorous activities and activities that strengthen muscles and bones (like jumping or climbing) at least 3 days per week.
**2. Sedentary Behaviour**
* Limit recreational screen time to 2 hours or less per day (e.g., watching TV, playing video games, scrolling social media).
* Break up long periods of sitting or being inactive.
**3. Sleep**
* Ages 5–13: 9–11 hours of good-quality sleep per night.
* Ages 14–17: 8–10 hours of good-quality sleep per night.
* Sleep should be consistent (same bedtime and wake-up time every day).
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What are the RDA for protein requiements for all 3 age catorgies (children)?
* 1-3 years: 1.05 g/kg (13 g/d)
* 4-8 years: 0.95 g/kg (19 g/d)
* 9-13 years: 0.95 g/kg (34 g/d)
* Adults: 0.8 g/kg (60 g/d for 75 kg person)
160
What is the ADMR of protein for children?
* 1–3 years: 5–20%
* 4–18 years: 10–30%
* Adults: 10-35%
161
Why is the RDA for protein less in g/kg/d for preschoolers (4-8y) than toddlers (1-3 y)?
A. Growth of preschoolers has slowed, so relatively less protein is needed for deposition
B. Preschoolers are less active than toddlers, so they need relatively less energy
C. Both of the above
A. Growth of preschoolers has slowed, so relatively less protein is needed for deposition
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Is protein inadequacy likely to be a problem for Canadian children?
A. Yes, this is a major public health concern and priority for Canadian children because protein inadequacy is widespread
B. No, most Canadian children have adequate protein intakes
C. I’m not sure
B. No, most Canadian children have adequate protein intakes
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JR is an active 6-year old male who weighs 20.7 kg. Their EER is 1742 kcal.
1. What is their RDA for protein?
2. Would this be hard to achieve?
3. What % energy does the RDA provide? (Use their EER for total energy here)
4. What is their AMDR for protein?
1. 0.95 g/kg x 20.7 kg = 19.7g/d ~20 g/d
2. No
3. 20 g x 4 kcal/g = 80 kcal/1742kcal = ~5%
4. aim ~40g/g to meet 10%
164
What is the ADMR for fats in each age category for children?
Acceptable Macronutrient Distribution Range for fat:
* 30-40% of energy (age 1-3)
* 25-35% of energy (ages 4-18)
* 20-35% of energy (adult)
165
What are the iron requirements in childhood?
Iron requirements are determined by factorial method considering amounts needed to:
* Replace daily iron losses
* New tissue growth, including RBC
* Storage
* Additional iron for menstrual losses are added in once menstruation commences
166
What are the RDAs of iron for children?
* 7 mg/d (age 1-3)
* 10 mg/d (age 4-8)
* 8 mg/d (age 9-13) *After age 9, stores are assumed to be replete RDA for children consuming plant-based diets: 1.8X these values
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Is iron deficiency common in Canadian children?
A. Yes, iron deficiency is even more common in childhood than infancy
B. Yes, iron deficiency is common in childhood and many are anemic
C. No, most Canadian children have adequate iron intakes and few are anemic
C. No, most Canadian children have adequate iron intakes and few are anemic
On average, 1000 kcal of an average mied diet provides 6-7 mg iron
168
What is the RDAs of calcium for children?
* RDA: age 1-3: 700 mg
age 4-8: 1000mg
age 9-13: 1300 mg
169
What is calcium important for children?
* Based on intakes associated with maximal accretion of bone during growth
* Maximizing bone mass in childhood/adolescence may decrease fracture risk in later life
Higher peak bone mass accretion = lower risk of osteroporosis and fracture risk in later life
170
What includes in buidling healthy lifestyles for children?
Ultra-processed foods ↔ Sedentary lifestyles
- Increased risk of chronic disease later in life
Less processed foods ↔ Active lifestyles
Reduced risk of chronic disease later in life
171
What is adiposity rebound?
* After the first year, BMI declines and reaches a
minimum ~age 5–6
* Point of minimum BMI = adiposity rebound
* Early adiposity rebound is a risk for adolescent/adult obesity
172
At age 4, Kenny weighed 18 kg and was 105 cm tall. At age 10, Kenny weighs 39 kg and is 140 cm tall. Which of the following is the most appropriate interpretation of this?
A. Age 4: normal range; Age 10: normal range
B. Age 4: normal range; Age 10: overweight
C. Age 4: normal range; Age 10: obese
D. Age 4: overweight; Age 10: obese
E. Age 4: underweight; Age 10: underweight
B. Age 4: normal range; Age 10: overweight
173
What are childhood feeding challenges?
* Decreased appetite
* Changing preferences
* Food neophobia
* Food jags
* Picky eaters
* Unrealistic expectations
174
Whar are children appetite, preferences & food jags?
* Children go through times when they are not
interested in food – may eat very little
* Children may go on a “food jag” – only want to eat
one (or a few) favourite foods for a period of time
* Children’s food preferences also change frequently
* All of this is NORMAL
* Parents should offer a variety of healthy choices and not force children to eat
175
What is "picky eating"?
**Food neophobia**: Unwillingess/reluctance to try new foods
**Picky eating**: Unwillingness to try familiar foods
* Peak of pickiness ~ 2 y of age
* Prevalence estimates ranges from ~5% to 50%
176
What are tipes for overcoming picky eating?
* Offer foods more than once
* Involve children in food selection and meal preparation
* Never force foods or use food as reward
177
What are feeding issues in children?
* Dysphagia (swallowing difficulty)
* Choking, gagging, coughing
* Crying while eating
* Vomiting and/or Diarrhoea
* Rashes or other signs
178
Food additives, such as dyes, have been shown to increase risk of ADHD and worsen symptoms in those with diagnosed ADHD
A. True
B. False
B. False
179
After eating foods high in added sugars, children are more likely to be hyperactive
A. True
B. False
B. False
180
What are the two screening tools to assess risk in older adults?
1. **SCREEN**: **S**eniors in the **C**ommunity: **R**isk **E**valution for **E**ating and **N**utrition
- is an upstrem nutrition screening tool for community-dwelling older adults
- If SCREEN-8 OR SCREEN-14 refers high risk older adults to - recommend to profressionals, services, rescourses
2. **MNA**: validate nutrition screening and assessment tool that can identidy geriatric patients age 65 and above who are malnourished or at risk of malnutrition
181
Define the acronym ABCDE for assessment?
Anthropometrics
- weight and height
Biochemistry
- bloodwork
Clinical
- disease, functional, etc,.
Dietary
- Food intake
Environment
- income, food insecurity
