Human Nutrition Chapter 8: Adult Nutrition

Adult Nutrition

• Segments of adulthood:
  • Early adulthood: 20-39 years
  • Midlife: 40-49 years
  • Later adulthood: 60+ years

Importance of Nutrition

• Between 20 and 64 years, diet, physical activity, smoking, and body weight influence future health and wellness
• Nutrition and exercise can reduce the onset and severity of five out of ten leading causes of death:
  • Heart disease
  • Stroke
  • Diabetes
  • Some cancers
  • Liver disease

Health Disparities Among Groups of Adults

• Some population groups have a higher prevalence of chronic diseases than others
• Genetic disposition, lifestyle, and environment interact to influence health

Physiological Changes of Adulthood

• Growing stops by the twenties
• Bone density continues until age 30
• Muscular strength peaks around 25-30 years
• Dexterity and flexibility decline
• Hormonal shifts and body composition changes occur slowly

Hormonal and Climacteric Changes

• Women:
  • Decline of estrogen leads to menopause
  • Increase in abdominal fat
  • Increase in cardiovascular disease risk
  • Accelerated bone mass loss
• Men:
  • Gradual decline in testosterone level and muscle mass

Body Composition Changes in Adults

• Bone: bone loss begins around age 40
• Adiposity: positive energy balance leads to increased weight and adiposity
• Gut microbiome: shifts occur due to factors like diet, illness, and medication

Continuum of Nutritional Health

• Nutritional health can be viewed as a continuum:
  • Resilient and healthy state
  • Altered substrate availability
  • Nonspecific signs and symptoms
  • Clinical condition
  • Chronic condition
  • Terminal illness and death

Energy Recommendations

• Energy requirements: amount of dietary energy needed to maintain stable body weight
• Age-related changes in energy expenditure: declines in early adulthood
• Estimating energy needs: based on basal metabolic rate, thermic effect of food, and activity thermogenesis

Nutrient Recommendations

• Macro and micro nutrient recommendations:
  • Macronutrients: carbohydrate, fat, and protein
  • Micronutrients: vitamins and minerals

Risk Nutrients

• Fiber: decreases diet energy density, linked to lower body weight and weight gain
• Calcium and vitamin D: crucial for bone health
• Vitamin A and vitamin E: antioxidants
• Choline: important for brain function and metabolism
• Potassium and sodium: influence blood pressure

Dietary Recommendations for Adults

• Dietary guidance systems:
  • Sets of dietary and lifestyle recommendations
  • Based on latest scientific information
  • Developed to promote health and prevent disease
  • Key components: Dietary Guidelines for Americans and MyPlate

Physical Activity Recommendations

• Healthy eating and increased physical activity combat obesity
• Guidelines for physical activity:
  • Any physical activity is better than none
  • Regular physical activity reduces disease risk factors

Nutrition Intervention for Risk Reduction

• Strategies to promote nutritional health:

  • Individual counseling
  • Multicomponent programs
  • Policy and system changes
  • Public food and nutrition programs
  • Community-based programs### Overweight and Obesity

• BMI is used to classify obesity and associated risks, which is correlated with total body fat and calculated from height and weight.

• Waist circumference is used to measure central adiposity, which is highly correlated with metabolic abnormalities and chronic diseases.

• A modest weight gain of 11-19 kg since young adulthood is associated with a twofold increase in risk of chronic disease.

Screening and Assessment

• Nutrition assessment is used to understand overweight experience, current eating and activity patterns, psychosocial and medical factors, motivation, and readiness to change.
• Several factors contribute to understanding motivation to engage in a weight-loss program.

Intervention in Obesity and Overweight

• Relatively small amounts of weight loss (3-5-10% of body weight) can reduce or prevent obesity health risks.
• A comprehensive weight management program is needed for successful weight loss, including diet, physical activity, and behavior therapy.

Weight Loss Goals

• Prevent further weight gain, reduce body weight, and maintain a lower body weight for the long term.
• Medical nutrition therapy for weight management involves reducing caloric intake, meal replacements, and cognitive behavioral therapy.

Cognitive Behavioral Therapy

• Cognitive restructuring and stimulus control are used to recognize and replace automatic and irrational thoughts and beliefs, and increase awareness and control of cues associated with eating.
• CBT should not be used alone to lose weight, but rather to support lifestyle changes.

Components of Weight Management

• Realistic goals, caloric deficit, meal plan, skill development, problem-solving techniques, self-monitoring, and management are components of weight management based on cognitive behavioral therapy.
• Cognitive restructuring, stress management, support system, regular exercise, and maintenance are also important components.

Physical Activity for Weight Management

• Physical activity contributes to energy deficit, and obese individuals should initiate physical activity and increase intensity slowly.
• Moderate physical activity of 30 minutes per day, five days a week, may burn about 1000 calories, and reduces diabetes and cardiovascular risk.

The Challenge of Weight Management

• After six months, the rate of weight loss declines and plateaus, and metabolic compensation is about eight kcal/lb lost/day.
• Successful weight loss maintenance requires using more behavioral strategies, such as consistently controlling calorie intake, exercising more often and strenuously, tracking weight, and eating breakfast.

Pharmacotherapy for Weight Loss

• Comorbidities and risk factors may warrant the use of weight loss drugs, and medications combined with lifestyle modification are most effective.
• Over-the-counter and herbal weight-loss preparations have not been tested for efficacy and safety, and are not recommended.

Bariatric Surgery

• Bariatric surgery is reserved for patients with clinically severe obesity who meet criteria, such as a BMI ≥ 40 or ≥ 35 with high risk for obesity-related morbidity or mortality.
• Patients must be highly motivated for aftercare guidelines, and are at risk for micronutrient deficiencies.

Cardiovascular Disease

• Cardiovascular disease is related to the heart and blood vessels, and is usually associated with atherosclerosis.
• Hyperlipidemia and hypertension are important factors in CVD progression.

Prevalence of CVD

• Over 83 million adults have CVD, with men developing it at a younger age, and women catching up after menopause.
• Racial and ethnic differences occur, and CHD is the number two cause of death in U.S. adults aged 34-64.

Etiology of Atherosclerosis

• Fibrous plaque formation begins when fatty deposits become part of tissues that form over injured arterial wall cells.
• Atherosclerosis reduces blood flow, vessels lose flexibility, and the heart has to work harder, leading to higher blood pressure.

Risk Factors for CVD

• Dyslipidemia, high blood pressure, lifestyle factors of diet or physical inactivity, smoking, genetics, obesity, and diabetes are risk factors for CVD.

Screening and Assessment of CVD

• Screening should occur about every five years, beginning at age 20, and levels of the factors listed are used to target interventions and determine the aggressiveness of therapy.

Nutrition Assessment

• Key assessment components include food and nutrition history, nutrition knowledge, physical activity, anthropometric measurements, laboratory values, and medical and social histories.

Nutrition Interventions for CVD

• Primary prevention involves a cardio-protective diet, which emphasizes plant foods, appropriate fats, fish, poultry, legumes, nuts, and low-fat dairy.
• Therapeutic lifestyle changes involve more intensive intervention, including behavioral counseling and follow-up by healthcare providers.

Metabolic Syndrome

• Metabolic syndrome is a cluster of altered metabolic conditions that come together in a single individual, placing them at high risk for coronary artery disease, stroke, and type 2 diabetes.
• Abdominal obesity, elevated blood pressure, insulin resistance, and dyslipidemia are components of metabolic syndrome.

Prevalence of Metabolic Syndrome

• Metabolic syndrome affects over a fifth of U.S. adults, with prevalence declining slightly in 10 years, but metabolic conditions leading to diagnosis have changed substantially.

Etiology of Metabolic Syndrome

• Metabolic syndrome is thought to result from central adiposity and insulin resistance, and increases the risk for several chronic conditions.

Screening and Assessment

• Waist circumference, fasting lipid profile, and other risk factors are used to screen and assess metabolic syndrome.

Nutrition Interventions for Metabolic Syndrome

• Reduce the risk of atherosclerotic diseases and progression to diabetes, and intervene on the problems identified.

Diabetes Mellitus

• Diabetes is a chronic disease associated with abnormally high levels of blood glucose, and is classified into type 1, type 2, and prediabetes.

Prevalence of Diabetes

• Over 28.9 million adults over 20 years have diabetes, and over a third of adults have prediabetes, which correlates with overweight and obesity.
• Diabetes is more common in racial and ethnic minorities, and is increasing in younger adults and children.

Etiology of Diabetes

• Type 1 diabetes is a progressive autoimmune disease, while type 2 diabetes is characterized by insulin resistance that develops over time.

Physiological Effects of Diabetes

• Diabetes has numerous physiological effects, including frequent urination, increased thirst, increased hunger, fatigue, weight loss, and blurred vision.

Screening and Assessment

• Risk factors for diabetes and prediabetes include a parent or sibling with diabetes, history of gestational diabetes, elevated A1C, IFG, or IGT, racial or ethnic background, sedentary lifestyle, hypertension, low HDL, high triglycerides, or CVD.

Nutrition Assessment

• Diabetes management plan determinants include weight status, current eating pattern, knowledge about diabetes, physical activity, laboratory values, medical and social history, and past education and experiences.

Interventions for Diabetes

• Management of diabetes involves clinical goals, including normalizing blood glucose and glucose metabolism, preventing or slowing the progression of diabetes complications, and normalizing lipid levels and blood pressure.
• Patient-centered care is provided by a collaborative, interdisciplinary team.

Medical Nutrition Therapy for Diabetes

• Diet flexibility and individualization are important, and diet plan, calorie level, dietary intake, physical activity, and medications are considered.

Carbohydrate Management

• Carb counting involves classifying foods into groups with similar carbohydrate, protein, and fat profiles, and the plate method is a simpler, but less accurate, approach.

Self-Monitored Blood Glucose

• Glucometer is used to record values, and benefits include aiding weight loss and maintenance, and improving insulin/glucose profile.

Physical Activity in Diabetes Management

• Physical activity aids weight loss and maintenance, and improves insulin/glucose profile, as well as reducing lipids and blood pressure.

Herbal Remedies and Other Dietary Supplements

• Few are supported, and caution is necessary.

Cancer

• Cancer is a group of diseases in which genes malfunction, resulting in unregulated cell growth and tumor formation.

Prevalence of Cancer

• Cancer is the first leading cause of death for adults 45-65, and the third leading cause of death for adults 24-44.

Etiology of Cancer

• Cancer is caused by exogenous and endogenous factors, and age is associated with, but not dependent on, cancer development.

Screening and Assessment

• Modifiable risk factors and primary prevention involve smoking, obesity, insulin resistance, excess alcohol consumption, and poor dietary habits.
• Primary prevention involves early screening.

Nutrition Assessment Following Diagnosis and During Treatment

• Anthropometrics, food and nutrition history, medical and social history, and other factors are used to assess nutrition following diagnosis and during treatment.

Nutrition Interventions for Cancer

• Prevention involves healthy diet and physical activity, treatment involves medical nutrition therapy, and periods of remission involve healthy eating.
• Nutrition care during advanced stages of the disease involves adjusting food and fluid intake.

Alternative Medicine and Cancer Treatment

• Some herbal products have potentially useful roles in ameliorating nausea and common symptoms, such as ginger capsules and ginger or chamomile tea.

This quiz covers the nutrition needs of adults across different life stages, including early adulthood, midlife, and later adulthood. It includes topics such as food planning, preparation, and independence.