Adult Stages and Nutrition

• Copyright of the source material is 2017 Cengage Learning.

Adult Stages

• Renewed interest in nutrition often occurs during early adulthood to ensure the kids' are eating well.
• During midlife in the forties, managing schedules and meals becomes challenging due to active family responsibilities and mortality recognition.
• In the fifties, the "Sandwich" generation consists of multigenerational caregivers with many health concerns.
• In later adulthood, sixty-plus, greater attention is paid to physical activity and nutrition.

Importance of Nutrition

• Future health and wellness are influenced by diet, physical activity, smoking, and body weight between ages 20 and 64.

Physiological Changes of Adulthood

• Growing stops by the twenties.
• Bone density continues until age 30.
• Muscular strength peaks around 25 to 30 years, then dexterity and flexibility decline.
• Other body composition changes slowly occur in tandem with hormonal shifts.

Hormonal and Climacteric Changes

• Decline of estrogen in women leads to menopause, resulting in increased abdominal fat, loss of lean body mass, increased cardiovascular disease risk, and accelerated bone mass loss.
• Gradual decline in testosterone level and muscle mass in men results in loss of bone and muscle mass, insulin resistance, and increased risk of cardiovascular disease.
• Growth hormone (GH) secretion and concentrations fall with age (somatopause), with a decline in insulin-like growth factor 1 (IGF-1).
• Endocrine changes include a reduction in protein synthesis, a decrease in muscle and bone mass, and a decline in immune function.

The Adult Years: Body Composition Changes

• During the third decade of life, lean body mass and bone mass decline, while adipose tissue increases.
• Weight may stay the same with loss in lean body mass but with a concurrent gain in fat mass.

The Adult Years: Lean Body Mass Changes

• Sarcopenia is the age-related decline in lean body mass, distinct from cachexia, and a metabolic consequence of aging.
• Presarcopenia involves loss of muscle mass.
• Sarcopenia is the loss of muscle mass and strength.
• Severe sarcopenia is muscle mass loss accompanied by loss of both strength and physical performance.
• Lean body mass loss often begins in the third decade of life.
• Physical inactivity can lead to a loss of 3–5% of muscle mass per decade.
• Protein synthesis decreases with aging, with little change in protein degradation; muscle turnover and repair are likely decreased with age.
• Diet and exercise are modifiable factors that impact lean body mass loss.
• Reduced food intake associated with aging makes nutrient density of diet important.
• Sarcopenia is linked to vitamin D, protein, carotenoids, selenium, vitamins C and E.

The Adult Years: Bone Health Changes

• Bone mass loss starts around age 34.
• Decreases in estrogen in men and women, and testosterone in men, lead to bone mass decline.
• Lifestyle, mainly diet and exercise, influences approximately 20–40% of bone mass.
• Micronutrients like calcium, phosphorus, fluoride, magnesium, sodium, and vitamin D are crucial to bone health.

The Adult Years: Metabolic Changes

• Resting metabolic rate (RMR) decreases with age.
• RMR reduction is greater than can be explained by body composition changes.
• RMR may be lowered by slowing organ metabolic rates with age.
• Further research is needed to examine how RMR changes as individuals age.

The Adult Years: Importance of Nutrition and Physical Activity

• Nutrition and physical activity are important for staying healthy throughout the adult years.
• Key disease prevention factors include eating a healthy diet, consuming adequate nutrients, and maintaining a healthy weight via diet/exercise.

States of Nutritional Health

• Resilient and "healthy" metabolic systems are in homeostasis; organs are functioning at optimal level.
• Nutritional guidance should encourage adequate intake without excess, emphasizing "moderation, variety, and balance."
• Altered substrate availability is an early, subclinical state of nutritional harm when intake doesn't meet needs.
• Loss of reserves and/or accumulation of excess can lead to buildup of by-products.
• Dietary guidelines inform people of common risks and encourage healthful diets and lifestyle choices.
• Insufficient or excessive intake of nutrients or energy leads to observable changes and well-recognized risk factors for chronic disease called nonspecific signs and symptoms.
• Dietary guidance targets specific risk factors and observable signs and symptoms; it measures and monitors progress to halt or reverse risk factors for disease.
• Genetic predisposition, interacting with dietary components and environmental factors, influences the development of clinical conditions.
• Clinical conditions can be difficult to change, requiring intensive intervention like medical nutrition therapy or therapeutic behavior-change programs.
• In chronic conditions, altered metabolism and structural changes in tissues become permanent and irreversible with examples being structural damage to coronary arteries, invasive and metastatic cancer, or loss of kidney function or blindness.
• Intervention for chronic conditions is aimed at managing the condition.
• As for terminal illness and death, it is the final stage in the continuum in which complications advance, body systems shut down, and life ceases.

Estimating Energy Needs in Adults

• Energy needs are based on basal metabolic rate, thermic effect of food, and activity thermogenesis.
• Basil metabolic rate (BMR) accounts for 60 to 75 percent of involuntary processes.
• Thermic effect of food (TEF) requires about 10 percent for food metabolism.
• Activity thermogenesis or Physical activity level (PAL) accounts for 20-40 percent of total energy needs.

Calculate Estimated Energy Requirement (EER)

• Table 16.4 provides guidelines.
• Adjust EER by height.
• Adjust the EER by body weight if BMI is 25 to 40.

Energy Adjustments for Weight Change

• One pound of body weight is approximately equal to 3500 calories.
• An adult needs to create a negative balance of 500 calories per day to lose one pound a week.
• Decreased intake and increased activity may lead to a negative balance.

Energy Balance

• Pay attention to the balance between energy in and energy out.
• Reduction of total energy intake enhances weight loss regardless of macro diet composition.

Nutrient Recommendations

• Macronutrients include carbohydrate, fat, and protein.
• Intakes are expressed in ranges of percentage of total calorie intake.
• Fat: 20-35 percent of calories
• Carbohydrate: 45-65 percent of calories
• Protein: 10-35 percent of calories

Nutritional Recommendations

• Micronutrients are consumed at levels < the EAR or Al
• The underconsumed micronutrients are potassium, choline, magnesium, calcium, and vitamins A, D, E, and C.
• Iron deficiencies are apparent in adult women ages 19–50 years
• This results from low intake of vegetables, fruits, whole grains, and dairy
• Nutrients include calcium, potassium, and vitamin D.
• Iron is also a necessary nutrient for women of childbearing age or who are pregnant.

Focal Points of Dietary Guidance Systems

• Guidance systems should increase consumption of fruits, vegetables, fiber, and low-fat dairy products.
• Guidance systems should limit saturated and trans fat intake.
• Guidance systems should avoid processed meats.
• Guidance systems should keep sugar and sodium intake low.
• Guidance systems should ensure regular physical activity.
• Guidance systems should assist you in balancing energy intake with expenditure.

Dietary Recommendations for Adults

• Adopted through use of 2020 Dietary Guidelines and USDA food patterns
• Total diet approach should utilize nutrient-dense food
• Monitor portion sizing

Physical Activity Recommendations

• Healthy eating and increased physical activity are featured for combating obesity
• Any physical activity is better than none
• Physical activity helps to manage weight and reduce disease risk factors
• Aerobic and muscle-strengthening activity can come from adult physical activity.
• 150 minutes (2 hours and 30 minutes) a week of moderate-intensity or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity.
• Or an equivalent combination of moderate- and vigorous-intensity aerobic activity
• Aerobic activity has health benefits, including a decreased risk of premature death, decreased coronary heart disease, stroke, and HTN
• As adults increase time spent exercising to 300 minutes per week, benefits include decreased risk for colon cancer, breast cancer, and weight gain
• Muscle-strengthening activities deliver additional benefits, including improved bone strength, maintenance of muscle mass, and muscular fitness
• Adults should engage in muscle strengthening activities for all the major muscle groups at minimum 2 days per week

Overweight and Obesity

• Over one-third of U.S. adults are obese while another third are overweight.
• Overweight: BMI ≥ 25
• Obese: BMI ≥ 30
• Waist circumference and waist-to-hip ratio also used to measure body fatness
• Increased in the U.S.
• Southern states: 30.2%
• Midwest: 30.1%
• Northeast: 26.5%
• West: 24.9%
• Pear vs. apple shape dictates where fat will be stored
• Abdominal fat (visceral) fat can lead to increased levels of lipids/increased risk of cardiovascular disease.

Risk Factors of Overweight and Obesity

• Age
• Race and ethnicity
• Education
• Income
• Family history
• Physical activity
• Environment
• Alcohol
• Smoking
• Sleep deprivation

Screening and Assessment for Overweight and Obesity

• BMI and correlated body fat.
• Visceral fat, potbelly apple shape

Prevention of Overweight and Obesity

• Healthy eating, regular exercise
• Universal public health prevention that is aimed at the entire population
• Selective prevention that is aimed at those individuals who have a higher risk of developing obesity
• Targeted prevention that is aimed at those high risk individuals who already have weight problems and who are at risk for becoming obese

Management of Overweight and Obesity

• Individualized care with prevent further weight gain
• Goal: prevent further weight gain
• Basic treatment plan for obese individuals should include weight maintenance followed by a small, gradual weight loss (5-10%) over a 6-month period and management of comorbidities
• Intervention in obesity and overweight by decreasing about three to five to ten percent of body weight can reduce or prevent obesity health risks
• Needed for successful weight loss, including diet, physical activity and behavior therapy

Dietary treatment

• Low-calorie diet that includes an energy deficit of 500-1,000 kcal/day
• Led by a dietitian
• Involves education on label reading, measuring portion sizes, and recording intake
• Involves using meal replacements at fixed calorie levels

Weight Loss Goals

• Prevent further weight gain
• Reduce body weight: 1/2 to 1 lb per week
• Maintain a lower body weight for the long term

Medical Nutrition Therapy

• Reduces caloric intake
• Meal replacements

Cognitive Behavioral Therapy

• Cognitive restructuring and stimulus control by helping one recognize and replace automatic and irrational thoughts and beliefs
• Increase awareness and control of cues associated with eating

Physical Activity

• The goal is energy deficit
• Initiate physical activity and increase intensity slowly
• Moderate physical activity of 30 minutes per day, five days a week may burn about 1000 calories
• Reduces diabetes and cardiovascular risk

Behavior Modification

• Self-monitoring food intake and activity level
• Controlling stimuli
• Slowing eating
• Building social support
• Internet and telephone allows individuals to have continuous and extended contact with a health team

Challenges of Weight Management

• After six months the rate of weight loss declines and plateaus
• Metabolic compensation (i.e., energy gap) is about eight kcal/lb lost/day
• Use more behavioral strategies
• Consistently control calorie intake
• Exercise more often and strenuously
• Track weight
• Eat breakfast

Pharmacotherapy for Weight Loss

• Approved for patients with a BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 when complicated by an obesity comorbidity
• Medications combined with life-style modification is most effective
• Over the counter and herbal weight-loss preparations have not been tested for efficacy and safety; not recommended

Bariatric Surgery

• Reserved for patients with clinically severe obesity who meet criteria (BMI ≥ 40 or ≥ 35 with high risk for obesity-related morbidity or mortality)
• Patients must be highly motivated for aftercare guidelines
• Patients are at risk for micronutrient deficiencies

Case Study

• Adam, 5'11", 190 pounds is a single father with two teenage sons
• He has a Software development job, traffic time 90min/d
• He likes the workplace cafeteria
• He usually consumes frozen-entrees and take-out every night as a hot meal
• He is a football and basketball fan and spends many hours watching TV games
• In his spare time, he is restoring an old car with his son

Questions

• BMI
• What is a healthy BMI for Adam?
• Lifestyle and dietary factors related to Adams weight status?
• Nutrition diagnosis?
• Dietary prescription? Goal?
• What intervention? Topics and suggestions discuss with Adam?
• What would you measure later to determine if Adam was making progress?

PES Statement

• A PES statement (or Nutrition Diagnosis Statement) is a structured sentence that describes the specific nutrition problem that you (the dietitian) is responsible for treating and working toward resolving, the cause/s of the problem and the evidence that this problem exists.
• The Problem is the Nutrition Diagnosis.
• The Etiology is the cause/s of the nutrition problem (Nutrition Diagnosis)
• The Signs and Symptoms of the nutrition problem (Nutrition Diagnosis) exists.
• PES Example: The person is obese due to excessive energy intake due to consumption of fast foods meals 1 time per day_, evidenced by BMI at the 97%tile.