Lecture6_Adults[ FINAK 1].pdf
Transcript
ADULTS DR. ABEER M. ALJAADI LE 6 Nutrition and Adults Chapter 16th : Nutrition Through the Life Cycle, 6e. Judith E. Brown LEARNING OBJECTIVES By the end of today’s lecture, students will be able to: 1. Discuss different types of nutrition-related risk factors and how they are monitored in adu...
ADULTS DR. ABEER M. ALJAADI LE 6 Nutrition and Adults Chapter 16th : Nutrition Through the Life Cycle, 6e. Judith E. Brown LEARNING OBJECTIVES By the end of today’s lecture, students will be able to: 1. Discuss different types of nutrition-related risk factors and how they are monitored in adults 2. Describe normal physiological changes in adulthood and how they are associated with the development and progression of chronic diseases 3. Identify nutrients that are consumed in excessive and inadequate levels and the consequences for adult health. ADULTHOOD Adulthood marks a long period between the active growth and development phases of infancy, childhood, and adolescence and the older adult phases where a concern is sustaining physical and mental capacity. Adulthood is subdivided into the following segments. Early Adulthood: 20s Independence New food skills (plan; buy; prepare) Around 30s – nutrition awareness for their kids Midlife: 40s sandwich generation - The phase around the fifties (multi generation - caring for the young and older parents plus career; esp. women) Health concerns Later Adulthood: early sixties Retirement; Food choices with chronic ADULTHOOD The span of years between ages 20 and 64 is a time when diet, physical activity, smoking, and body weight strongly influence the future course of health and wellness. During these 44 years, lifestyle choices interact with genetic endowment, social forces, and environmental factors to determine years of life and quality of life. Today, about half of all American adults are living with one or more preventable chronic diseases. During adult years The focus is on preserving health maintaining a healthy weight delaying or preventing the onset of chronic diseases Note Key Issues in Adulthood Conditions and Interventions in Adults Nutrition will be discussed in a more advanced course (MNT) MODIFIABLE NUTRITIONAL RISK FACTORS FOR CHRONIC DISEASES Cancer Carcinogenic diet Low fruit and vegetable intake Low level of antioxidants (especially vitamins A, C) Low intake of whole grains and fiber High dietary fat intake Nitrosamines, burnt and charred food High intakes of pickled and fermented food Alcohol consumption High animal-food, low plant-food intake MODIFIABLE NUTRITIONAL RISK FACTORS FOR CHRONIC DISEASES Heart Disease Atherogenic diet High saturated fat (>10% calories) Trans-fatty acid intake Dietary cholesterol intake >300 mg Low fruit and vegetable intake Low antioxidants Low intake of whole grains No or excess alcohol intake** High sodium intake Low potassium intake Low intake of milk and dairy foods High waist circumference (men >40 inches, women >35 inches) MODIFIABLE NUTRITIONAL RISK FACTORS FOR CHRONIC DISEASES Obesity Obesogenic diet Caloric intake exceeding needs Unstructured eating Frequent fast-food consumption High fat intake Sugar-sweetened beverage consumption Energy-dense, low-nutrient food choices Diabetes Atherogenic diet & Obesogenic diet Notes that Obesity (BMI >.30) and physical inactivity are also independent risk factors for all of the chronic conditions. PHYSIOLOGICAL CHANGES bone density until roughly age 30 Peak bone mass is related to the amount of dietary calcium and weight-bearing exercise in prior years Muscular strength peaks around 25–30 years of age and later dexterity and flexibility begin to decline, although regular use of muscles and weight training affects strength as well as muscle size and retention. The type and amount of physical activity has a significant impact on body composition, including lean body mass, fat accumulation and relocation, and bone density Sensory and perceptual abilities change. Hearing loss begins as early as age 25 (or earlier with exposure to loud music), and vision changes often become noticeable by age 40 lean body mass = Sum of fat- free body tissue: muscle, mineral (as in bone), and water. PHYSIOLOGICAL CHANGES Hormonal and Climacteric Changes Climacteric Changes : Point in life where crucial changes occur; refers to the loss of reproductive activity, marked by menopause in women and reduction in testosterone production in men. perimenopause and menopause An approximately 4-year period of decreasing estrogen production followed by the end of menstruation; a marking point for increased risk of cardiovascular disease and other chronic conditions for women. Menopause is associated with an increase in abdominal fat and significant increase in risk of cardiovascular disease and accelerated loss of bone mass estrogen, in both men and women, is involved in the supply of calcium to bones, health of blood vessel walls, blood cholesterol and TG levels, and elasticity of the skin. Obesity is associated with higher estrogen levels in men and women due to the production of estrogen by fat cells. After age 30, men experience a gradual decline in testosterone level and muscle mass. PHYSIOLOGICAL CHANGES Body Composition Changes in Adults Bone - loss begins around the 40s Adiposity - fat redistribution (more central; less subcutaneous) HTN; insulin resistance; CVD Gut microbiome Nutrients released - K, B12, biotin, carnitine Gut dysbiosis Breakdown in the balance of protective and harmful bacterial in the intestines. AGE-RELATED CHANGES IN ENERGY EXPENDITURE Metabolic rate and energy expenditure begin to decline in early adulthood at a rate of ~2.9 % for men and 2.0% for women per decade. These reductions generally correspond to declines in physical activity and lean muscle mass. Between ages 25 and 65, physical working capacity (measured by VO2 max) declines by 5–10 % per decade. The presence of musculoskeletal disease, obesity, and other conditions can accelerate declines in energy expenditure and physical capacity. NUTRIENTS AT RISK Fiber - reduces energy density and wt. control Potassium and Sodium: opposing effects on blood vessels K Supplement - not really obesity, diabetes, inflammatory bowel disease, More effective: high in fruits and vegetables and low-fat and CVD dairy products (all good sources of potassium) and low in Calcium and Vitamin D: Low vitamin D > less sodium (the DASH diet) calcium bioavailability. Combined with low dietary calcium intake by Magnesium: def >> calcium-activated inflammatory cascade independent of injury or pathogens; chronic adults, especially women, this leads to loss of inflammation impact? calcium from bones, which, in turn, leads to Peanuts - good source osteopenia—and progress to osteoporosis Vitamin A and Vitamin E: antioxidant functions; Iron: Anemia; work performance; cognitive function; cell repair (implications on cancer and immune immune function systems) Adiposity>> -ve effect on iron absorption Premenopausal women Choline: fatty liver and muscle deterioration CVD - homocyteine conversion STATES OF NUTRITIONAL HEALTH The continuum of nutritional health can be represented in six states or stages. 1- Resilient and “Healthy” - metabolic systems are in homeostasis, and organs are functioning at optimum level. - the body’s defenses and immune system can counter assaults from toxins, pathogens, and stress - Nutritional guidance and education: "moderation, variety, and balance.” 2- Altered Substrate Availability - early, subclinical state of nutritional harm occurs when intake does not meet needs. - a loss of reserves and/or accumulation of excesses. - Nutrition education and dietary guidance directed at the public attempts to inform people about common risks and encourages healthful diets and lifestyle choices to minimize or reverse subclinical changes. STATES OF NUTRITIONAL HEALTH 3- Nonspecific Signs and Symptoms - insufficient or excessive intake of nutrients or energy leads to observable changes. - e.g central adiposity - Dietary guidance, nutrition counseling, and medical nutrition therapy, delivered individually or in groups, are potential interventions to assist individuals in making changes at this stage. Goals of intervention target specific risk factors and observable signs and symptoms. 4- Clinical Condition - signs and symptoms of illness are now present and a medical diagnosis such as atherosclerosis, osteo- porosis, cancer, type 2 diabetes, or depression - intensive intervention such as medical nutrition therapy or therapeutic behavior change programs STATES OF NUTRITIONAL HEALTH 5- Chronic Condition - altered metabolism and structural changes in tissues become permanent and irreversible. - e.g coronary arteries damage; loss of kidney function - Intervention at this stage is aimed at managing the condition, preventing further complications, reducing the degree of disability, and optimizing quality of life. 6- Terminal Illness and Death - At the final stage in the continuum, complications advance, body systems shut down, and life ceases. SUMMARY 1. Individual choices as well as external factors strongly influence the course of health and wellness for adults. 2. There are significant disparities in the incidence and prevalence of disease across population groups. Social and economic disadvantage, along with other factors, are important determinants of nutritional and health outcomes. 3. Beginning early in the adult years, bone mass begins to decline, and there is an increase in body fat that is associated with increased risk of chronic diseases. 4. Subclinical nutritional injury begins long before observable signs and symptoms emerge. Early alterations in nutritional state can be reversed with changes in nutrition and physical activity. 5. Metabolic rate and energy expenditure decline through the adult years. Balancing energy intake and physical activity is necessary to maintain a healthy body weight. Several methods can be used to estimate energy needs. 6. Risk nutrients for adults include excessive saturated fat and sodium intake and inadequate intake of several vitamins, minerals, and fiber with important metabolic consequences.
