Chapter 13

1. Chapter 13 Nutrition Over the Adult Life Span

2. Learning Objectives • Explain how social, economic, and physiologic changes affect nutritional status over the adult life span. • Discuss nutrient needs over the adult life span. • Discuss common nutrition-related medical problems of the older adult.

3. Healthy Aging Aging process begins in utero Health behaviors in young adulthood affect aging process in older adults Field of gerontology (the study of the needs of older adults) continues to develop Goal to optimize one’s genetic potential for longevity and reduce the aging process Maintain stable, lean body weight via avoidance ofexcess kilocalories and inclusion of regular physical activity Maintain good nutritional intake of vitamins, minerals, proteins, essential fatty acids to allow for optimal cellular function

4. Childhood Eating Habits Affect Adulthood Eating Habits Current elderly population growing up in the Great Depression and most living on farms Wide variety of vegetables typically consumed Greater preference for organ meats with moreexperience of butchering on family farm or inclusion of wild game as primary meat source Current middle-age population most varied in childhood eating habits with transition to restaurant eating and fast foods beginning in the 1960s

5. Nutritional Concerns of Young Adults Increased rate of obesity beginning in childhood adversely affecting aging process with expected decrease in longevity among the obese population Weight gain in college: 4 lb in first semester common Found to be especially an issue with “all-you-can-eat” dining halls and dorm snacking Binge drinking common in colleges; 25% estimated to mix alcohol with caffeine-based energy drinks(O’Brien et al., 2008)

6. Nutritional Concerns of Young Adults (continued) Decreased energy expenditure with work and decreased time for physical activity promotes adult weight gain Increased weight with changes in eating habits: Dating and restaurant meals Business lunches Eating differences with partner or spouse

7. Late-Night Snacking Is Common in College Dorms

8. Other Social Changes Over the Life Span Decreased funds for food purchases: Younger adults living on their own Older adults who are retired Driving issues or lack of transportation: loss of independence Becoming a parent with altered eating habits because of children Not used to cooking for self; may gain weight with altered, easy-to-prepare convenience foods Depression from life changes or loss of spouse leads to impaired appetite and weight loss or increased intake and weight gain

9. Marriage Has Many Influences On Food Choices

10. Physical Changes Loss of muscle tone with decreased physical activity;loss of muscle mass/tone referred to as sarcopenia Approximately ½ lb muscle lost per year after age 35 Decreased muscle = decreased metabolism Therefore, weight gain occurs unless kilocalories aredecreased or exercise and muscle are increased Altered taste with disease states, medications, nutrient deficiencies (zinc) Loss of teeth with increased reliance on soft foods Decreased thirst perception with elderly population; risk of dehydration; dry mouth with swallowing difficulties

11. Younger Women’s Concerns Premenstrual syndrome Increased Ca++ (1300 mg) and vitamin D(700 IU) may reduce symptoms (Bertone-Johnson et al., 2005) Eating small, frequent meals may be helpful Severe forms may require medication Menstrual migraines: tend to be most severe form

12. Nutrient Needs Energy needs Young adults: 2000 to 2500 kcal (25 to 30 kcal/kg BW; 12 to 15 kcal/lb) Athletic adults: 3000 to 5000 kcal (30 to 50 kcal/kg BW; 15 to 25 kcal/lb) Older adults: max 2000 kcal (20 to 25 kcal/kg BW; 10 to 12 kcal/lb) Protein needs 0.8 g PRO/kg BW for most adults ≥1 to 1.2 g PRO/kg BW (max 2.0 g/kg BW) for elderly population or athletes

13. Nutrient Needs (continued) Older adults or sedentary young adults need to maintain vitamin and mineral intake while lowering kilocalories (i.e., need for nutrient-dense foods) Possible need for vitamin B12 injections as result of malabsorption with young adult (bariatric surgery or celiac disease) or lack of “intrinsic factor” with elderly population to prevent pernicious anemia

14. Other Nutrient Needs Iron foods or supplements for menstruating females; low iron for menopausal women Vitamin D for all adults living in northern climates— supplement generally required with expected increase in DRI (now 600 IU for persons age 70 years) to expected 800-1000 IU minimum Fluids: 1 mL/kcal; 30 mL or 1 oz/kg BW Athletes or adults with excess perspiration need additional fluid to replace losses

15. Menopause: Cessation of Menstrual Cycle Due to Loss of Estrogen Perimenopause: years preceding menopause Symptoms may tend to include weight gain, mood swings, increased cholesterol, hot flashes Hot flashes: related to increased peripheral blood flow. Also occurs in men treated with anti-androgens due to prostate cancer. Core body temperature increases. May benefit with small, frequent meals, avoidance of hot beverages

16. Impact of Decreased Muscle Tone Delayed digestion; issues with insoluble fiber (roughage) because of digestive problems May occur in disease states with young adultsor elderly population because of aging process Constipation from decreased gastrointestinal peristalsis; often complicated by dehydration and food choices (e.g., easier to eat low-fiber crackers than to cook vegetables)

17. Prevention of Sarcopenia Include adequate protein intake; at least 1 g/kg BW generally needed for older adults Avoid excess weight loss at any age; weight loss is not advised for the elderly population (Miller and Wolfe, 2008) Control inflammation (Schaap et al., 2006) Increase physical activity Leisure-type activity not sufficient to prevent sarcopenia (Raguso et al., 2006)

18. Hyponatremia: Caused by Excess Fluids Key distinguishing symptom from other exercise-induced collapse: vomiting; can lead to central nervous dysfunction Risk factors: Female gender >3 L fluids/hour for marathon runners; racing time >4 hours Low BMI Significant weight gain during or post-event (fluid retention) Prevention goals: Max 400 to 800 mL/hour (Individual needs may vary) 680 mg sodium/hour (⅓ tsp salt) with >4-hour endurance event

19. Sports Anemia Sports anemia is NOT iron-deficiency anemia; it is caused by an inflammatory process If indicators of anemia exist, rule out iron-deficiency anemia with iron studies (% iron saturation, TIBC, ferritin level); treat with iron only if there is iron-deficiency anemia If diagnosis of sports anemia is verified: Treat with rest to decrease inflammation Prevention may be facilitated with antioxidant vitamins A, C, and E

20. Alcoholism Common in all stages of adulthood Often hidden; be alert to signs of excess (e.g., lack of self-care) Elderly population more susceptible to effects because of decreased metabolism and possible dehydration

21. Anemia Iron deficiency: with young women due to menstruation; older adults due to GI blood loss Macrocytic anemia: B12 deficiency due to loss of intrinsic factor (transporting protein); occurs with aging or for anyone with gastric surgery (bariatric weight loss) or taking certain medications (e.g.,anti-reflux medications) Copper deficiency: generally caused by excess zinc supplementation Anemia of chronic disease: related to inflammation

22. Arthritis: A Condition of Inflammation Includes osteoarthritis, rheumatoid arthritis, gout Omega-3 fatty acids help lower inflammation Including antioxidants such as copper and zinc; selenium and vitamin D may be helpful(Rayman and Pattison, 2008) Including vitamin B6 can lower hyperhomocysteinemia associated with cardiovascular disease among those with arthritis(Woolf and Manore, 2008)

23. Benign Prostatic Hyperplasia May be related to hyperinsulinemia Treat with Weight management High-fiber diet Low-saturated fat (Barnard et al., 2008)

24. Bowel Management (BM) Constipation (goal BM >2 times/week); treat or prevent by Including adequate fiber (25 g per food labels) Including adequate fluids (30 mL per kg BW; most common need) Increase exercise that uses abdominal muscles Prune/prune juice believed to help due to natural sorbitol content Loose bowels/diarrhea May occur with antibiotic treatment; correct with livebacterial cultures (yogurt/buttermilk) or probiotics Increase in soluble fiber may be beneficial

25. Celiac Disease Found in about 1% of U.S. population; 3% to 8% with type 1 diabetes Common signs and symptoms: Fatigue, abdominal pain, bloating or gas, anemia, diarrhea, osteopenia/osteoporosis, skin problems (dermatitis herpetiformis), weight loss Rule out celiac with dx of IBS, fibromyalgia, or elevated liver enzymes (transaminases) Tests: IgA antihuman tissue transglutaminase (TTG), endomysial antibody (IgA-EMA), multiple biopsy sites from intestinal tract* Avoid all traces of gliadin protein found in gluten of wheat, rye, barley, and U.S. oats (because of cross-contamination) *With IgA deficiency, test for IgG-TTG/EMA

26. Cognitive Impairment Growing evidence that omega-3 fat intake through cold-water fish consumption is needed: “Fish is brain food” Possible causes: Stroke/TIAs, polypharmacy, deficiency of vitamins B1 (especially with alcoholism or diuretic use), B12, and folic acid (role of hyperhomocysteinemia), vitamins C and E, and minerals zinc and selenium Feeding issues result from the person forgetting how to chew and swallow in late stages of Alzheimer’s disease or as result of dementia from other causes

27. Gastroesophageal Reflux Disorder (GERD) May be explained as “heartburn” HCl from gastric secretions damage the esophagus Medical nutrition therapy includes following: Weight loss (reduced pressure on the stomach) Small, frequent meals (to avoid overextension of the stomach) Minimize stomach contents before sleeping with inclusion of low-fat meals or no food 3 to 4 hours before bed

28. Hearing Loss May be lessened with increased intake ofantioxidant vitamins Vitamin C may help prevent loss (McFadden et al., 2005)

29. Migraines: Related to Trigeminal Nerve Dysfunction/Hyperactivity May be induced by following: Magnesium deficiency (Mg+ works as a calcium-channel blocker) Impaired mitochondrial function: vitamin B2 may help Hypoglycemia: small, frequent meals may help prevent Lack of sleep and intervals of high stress Possible food triggers*: red wine, other alcohol, aspartame, chocolate, aged cheese, nitrates/nitrites, MSG, citrus, coffee/tea, pork, milk, nuts, and legumes *Consult with an RD if diet limited because of need to avoid triggers

30. Neurodegenerative Diseases Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS, or Lou Gehrig disease), Huntington’s disease Similar in regard to mitochondrial dysfunction; vitamin B2 may offer protection Resolving possible zinc deficiency may help prevention Potential role of vitamin B3 (nicotinamide) in prevention Possible prevention with omega-3 fats; anti-inflammatory action promotes neuronal health Impaired swallowing occurs with neurodegeneration

31. DETERMINE Checklist Disease Eating poorly Tooth loss or mouth pain Economic hardship Reduced social contact Multiple medicines Involuntary weight loss or gain Needs assistance in self-care Elder years—older than age 80

32. Food and Drug Interactions Polypharmacy in elderly population from use of Rx and over-the-counter preparations: Use of 3-7 medications common, with drug-to-drug interactions likely Multiple nutritional issues with variety of medications Increased risk due to organ deterioration, malnutrition, and underlying disease states