NALS Study Guide PDF

Chapters 12&13 (Child & Preadolescent Nutrition): What are the age ranges for “child” and for “preadolescent” (“girls” compared to “boys”)? Child: 5-10 years Preadolescent Girl: 9-11 years Preadolecent Boy: 10-12 years Girls mature at an earlier age on average than boys What are the trends in gr...

Chapters 12&13 (Child & Preadolescent Nutrition): What are the age ranges for “child” and for “preadolescent” (“girls” compared to “boys”)? Child: 5-10 years Preadolescent Girl: 9-11 years Preadolecent Boy: 10-12 years Girls mature at an earlier age on average than boys What are the trends in growth during adolescence, and how do these differ by sex? Weight increases 9 ounces/month Height increases.25 inches per month BMI should increase significantly between 6 and 12 Girls increase faster and earlier because body fat preparation for menstration What factors influence eating attitudes/habits in this age group? Which factors tend to be more influential and which ones become less influential at this stage of the human life span? Marketing, friends, school, sports, clubs, the internet Internal ques are most influential from 1-4 Know the DRIs for energy, protein, and total fat for the 4-8 y/o and the 9-13 y/o DRI age ranges. Energy: Girls: 3y = 15kcal/d; 4-8 years = 15kcal/d; 9-13 = 30kcal/d Boys: 3y = 20kcal/day; 4-8 years = 15kcal/d; 9-13y = 25kcal/day Protein: Same DRI for 4-8 and 9-13 years: 0.95 g/kg/d 4-8 years: 19 g/day 9-13 years: 34 g/day Fat: 25-35% kcal 1 year olds should be having low-fat milk, but for 1-2 year olds, whole milk o For energy, simply be familiar with the components that make up the EER equation used to assess energy needs. EER: Total expended energy + kcal for energy deposition Equations: Age group = 3 - 13 years (y) Sex = male or female (M or F) Weight in kilograms (kg) Height in centimeters (cm) Physical Activity Level (PAL) Categories = inactive, low active, active, or very active Energy allowances based on body weight are lower for school-aged children than for toddlers and preschoolers because growth rate slows down o Why is it better to express the protein requirement in the unit “g/kg/day” (so as “grams of protein needed for each kilogram of body weight per day”) than to express it as “g/day” (“grams of protein per day”)? Everyone has a different body weight o How is it possible that there is no difference in protein requirement expressed in “g/kg/d” when we go from 4-8 y/o to 9-13 y/o (both DRI age ranges have the same protein requirement of “0.95 g/kg/day”), but there is a large increase when we express protein requirement in “g/day”? (It is 19 g/day for 4-8 y/o and almost twice as much, or 34 g/day, for 9-13 y/o children.) If you understand the different units and what they mean (g/kg/day vs. g/day), then you have the answer. Differences in weight Know the DRIs for specific micronutrients (iron, zinc, calcium, and fiber) at 4-8 y/o and 9-13 y/o DRI age ranges. Nutrient 4-8 years 9-13 years Iron 10 mg/day 8 mg/day Zinc 5 mg/day 8 mg/day Calcium 1000 mg/day 1300 mg/day Fiber 25 g/day Girls: 26g/day Boys: 31 g/day How does fluid consumption (amount and choice of beverages) impact a child’s health (esp. bone health) and nutritional status (e.g., intakes of calcium, fiber, vitamin B12, zinc, iron, and fat)? Be familiar with the WHO’s statement on non-sugar sweeteners that we discussed in class. Up to 20% of kcal/day come from liquids for children 6-11. Decreases absorption of all of the nutrients but calcium because of milk consumption. Soda increases, milk decreases. The WHO basically says to avoid them. There are a couple of graphs that address different aspects of childhood obesity and trends in childhood obesity. You simply need to be aware of the “big picture” (i.e., main trends) that each graph illustrates. Do not worry about specific numbers or percentages. What are the main short-term effects of being overweight as a child? Girls are more likely to get obese the older they get Boys get obese between preschool and school-age What are the main long-term effects of being overweight as a child? (Some are short- and long-term effects – know those that are both). Short term: Early puberty, taller, increased bone density, but not good. Increased BP, insulin resistance, type 2 diabetes, psychological issues Long term: Obesity, some cancers, insulin resistance and diabetes, psych and self-esteem issues What are the main predictors of childhood overweight/obesity? Parents, genetics, food choices What are some of the main reasons for preadolescents to switch to a vegetarian diet? Parent eating practices, environmental concern, animal welfare, ecology What are the recommendations for children’s physical activity in the U.S.?  The NSLP Meal Pattern must provide what amount of the DRIs based on the child’s age and grade group (as an average per week)? How much of the DRIs must the School Breakfast Program provide? They need to provide ⅓ of the DRIs for school lunch They need to provide ¼ of the DRIs for school breakfast What are the 5 specific improvements that the USDA implemented back in 2012 as part the National School Lunch Program (NSLP)? 1) Lunches must be based on nutritional standards 2) Kids that can’t pay for lunch must get a reduced price with no discrimination 3) They operate on a nonprofit bias 4) The programs must be accountable 5) Schools must participate in a commodity program Chapter 14: Adolescent Nutrition Know all DRIs mentioned in class. The two exceptions here are for energy and for protein, where you do not need to know every number we addressed. Recall that there are three DRI age categories that apply to “adolescence”: 9-13 y/o; 14-18 y/o and 19-30 y/o. For energy and protein, the DRIs get more complicated since their requirements can be expressed in amounts (kcal/day for energy and grams/day for protein) and also in relation to the adolescent’s height (so, kcal/cm or g/cm). Don’t worry about the specific kcal/cm and g/cm values; simply know the trends (i.e., differences in male/female and how the values change as we move down the table from the 9-13 y/o to the 14-18 y/o and then to the 19-30 y/o DRI age range). Adolescent: 11-21 Energy increases as you are getting older o For the energy DRIs, just have a general idea of the differences in the ranges across age groups that I gave you in your note guide, and remember the energy changes per year starting at 19 y/o (which differ for males and females), which are relevant for the adult nutrition context as well. Why do energy needs differ for males and females during adolescence? o For protein know the g/day as well as the “g/kg/day” values for each gender/sex and age category (for example: 0.8 g/kg/day is the protein DRI for 19-30 y/o). Protein for adolescents: 0.85 g/kg/day Protein is highest for females at 11-14, and highest for males at 15-18 o For which nutrients are the DRIs the same for males and females and for which are they different? And why? Hint: Think of the key function(s) of each micronutrient. If the function is related to body mass, energy requirement and/or body composition, then you will typically see a difference in the DRI for males and females, since males (on average) tend to have a larger body; need more calories; and have more lean body mass compared to females of the same age. Calcium is the same for males and females Everything else is different What are the significant changes that occur during adolescence and how are they sex-specific? Hint: Think of sex-steroid hormones, sexual maturation, body composition, and the timing of peak velocity of growth in height, etc. Based on self-reported information (surveys), what are the general eating habits of adolescents Influence of peers is highest at 14-16 years old, and peaks in middle adolescence They are overall okay, but have some problems with meeting nutritional needs Lots of snacking and how have they changed from toddlers, school-aged children, etc.? Know “nutrients of interest” that we covered as part of adolescent nutrition (e.g., calcium, zinc, vitamin C, iron, folate, etc.). Know the DRIs; the function(s) of each nutrient in the human body; and good dietary sources for each nutrient. For females, the energy change is -7 kcal per day per year older than 19 For males, the energy change is -10 kcal/day per year older than 19 years 2 factors that influence protein requirements in adolescent are growth rate and lean body mass Communicating “nutrition messages”: How do we “reach” adolescents effectively? Remember: Keeping it relevant; focus on the adolescent’s control and diet choices; focus on health-centric messages rather than weight-centric ones (There is no place for “weight-shaming/body- shaming” or shaming of any kind when it comes to your client’s diet or food intake. Recall that “weight biases” are more common than even “race biases” and “age-related biases”... all of them are far too common. We can all do our part to change that by practicing inclusion, tolerance, kindness, and compassion.) Other effective communication and nutrition counseling methods include: making it fun; being positive, supportive, realistic and encouraging; providing a conducive environment for counseling by having a warm and welcoming atmosphere and body language; setting clear goals/expectations that are attainable and sustainable; set-backs will likely happen as part of making long-term dietary changes. Setbacks can be discouraging, but they can also provide opportunities for re-evaluating the approach and they can be empowering if we learn to overcome them in constructive ways. Review the information on “Weight Cycling During Adolescence and in Adolescent Athletes”. I would like for you to be familiar with this content because it is relevant for us in this field, specifically as it relates to “sports nutrition”, coaching, and athletic training. They weight cycle to enhance performance, to make a weight category, and to enhance aesthetics Active method: sweating out Diet-induced: consuming foods to induce fluid loss Taking diuretics Very low calorie diets Risks include cardiovascular problems, endocrine problems, thyroid function problems, immune system problems Chapter 15: Adolescent Nutrition - Conditions & Interventions  Familiarize yourself with the general trends in adolescent overweight and obesity and how these have changed over time. Adolecent overweight and obesity rates continue to rise Be familiar with the Intensive Health Behavior and Lifestyle Treatment recommendations for adolescent obesity. What other treatment options may be utilized for adolescents with obesity and under what circumstances? “Team approach to care” Why do we need different evaluation methods for adolescents compared to adults when it comes to blood pressure/hypertension? Also note that BP is evaluated based on “systolic by height percentiles” and “diastolic by height percentiles”, which means that it is interpreted in relation to the adolescent’s height, which in turn is assessed by using CDC growth charts and is expressed as a percentile; not simply as a unit of height given in feet and inches or in meters and centimeters. Know the risk factors for iron deficiency. There are many of them which is why “iron deficiency” is not uncommon. In fact, it is the most common nutrient deficiency during adolescence. Rapid growth Low iron-rich foods Low vitamin C Dieting Vegan diets Meal skipping Strenuous sports Heavy period Which nutrients might a vegetarian (or vegan) adolescent be lacking? What dietary recommendations would you make to increase the consumption of these nutrients? For example, if someone is borderline deficient in omega-3 fatty acids, what are some foods that you can recommend that are high in omega-3 FAs? What else can you recommend if this person does not eat the food sources you suggested? For example, salmon is an excellent dietary source of omega-3 fatty acids, but many individuals (not just vegetarians) do not eat fish. What else could you recommend as sources of omega-3 fatty acids? Iron (Esp. heme) Zinc Vitamin D3 Vitamin B12 Omega 3-s (Flaxseed oil, chia seeds, hemp seeds, walnuts) Possibly Calcium (if vegan) What is “gynecological age” and why is it important in the context of teenage pregnancy or in the context of the “staged care process” for weight management/weight loss? Current age - Age of first period 19-13 = 6 (No room for potential growth) Used to determine if adolescent still has potential for growth If less than 2 years since first period, still potential for growth Be familiar with some of the powerful statistics related to eating disorders. Hint: This is located under the heading, “Sobering Statistics on Eating Disorders” in your PP slide deck for Chapter 15. -20 million females and 10 million males struggle with eating disorders (EDs) in the United States. -Current U.S. population is around 330 million, so that's ≈9%! -Girls who diet are 12 times more likely to binge as girls who do not. -81% of 10-year-olds are afraid of being fat -60% of 3rd graders are more afraid of "being fat" than losing a parent! -1 in every 4 individuals are struggling with disordered eating patterns -Anorexia Nervosa (AN) has the highest death rate of any mental illness (approx.10-15% of patients with AN) -Eating Disorders are not marked as the cause of death on death certificates, so it is difficult to assess mortality rates. -95% of all dieters will regain their lost weight in 1-5 years. (Diets don't work!) What are signs that someone is developing an eating disorder and why are adolescents particularly vulnerable? Know the continuum of weight-related concerns and disorders and how a clinically significant eating disorder differs from disordered eating. Body dissatisfaction, dieting behaviors, Disordered eating, BED, Bulimia, Anorexia Review the horizontal bar-graph showing the relationship between NIH funding (# of $ in millions) and the prevalence of four mental illnesses (expressed in # of people in millions). This shows us the disparity in how research dollars are allocated. What is orthorexia and why is it on the rise in this country? Obsession with eating “healthy”, media Eating disorders are the leading mental health problem to cause death, yet have the least amount of money spend on them What considerations should be made in effectively treating an eating disorder? § Doctor § Psychologist / psychiatrist § Nutritionist / Registered Dietitian § Who else should be part of this team-based treatment approach? 3 Main Goals of Eating Disorder Treatment Programs: 1. Restore body weight 2. Improve social and emotional well-being 3. Normalize eating behaviors Role of Nutritionist / Registered Dietitian: · Nutrition education and counseling to normalize food-related thoughts and beliefs · Should not force person to gain too much weight too fast: *TRUST is essential! Chapter 16: Adult Nutrition Know what is important for this age group: Details about health promotion/maintenance; reduction of risk factors for chronic diseases, etc. -the focus has shifted from utilizing a well-balanced diet to maximize growth and development to now employing a nutritious diet for health maintenance, cellular/tissue repair, and disease prevention. Maintenance: -overall health -energy level -mobility -weight status/ BMI -muscle mass -skeletal mass -Reduction in risk of chronic disease (but should start in childhood): -heart disease -osteoporosis -insulin resistance -cancer -arthritis -metabolic syndrome -stroke -diabetes -Reducing effects of chronic disease: examples = regression of plaques via pharmaceutical agents, control of blood sugar through dietary modifications, weight loss to reduce insulin resistance What are the stages of nutritional health? Be able to identify where someone falls on this continuum if I give you an individual’s circumstance/stage of illness or condition. Know information about evaluating and managing weight (e.g., know how we interpret ranges of BMI). Keep in mind that BMI is a crude assessment. Weight gain in both men and women "starts" around age 40 -men: some effect of hormones, but mostly related to decreased physical activity -women: lower estrogen levels (increased abdominal fat) AND decreased physical activity Effects of Estrogen Decline (as part of the natural aging process) Menopause is associated with an increase in abdominal fat and significant increase in risk of CVD and accelerated bone loss. In both genders, estrogen is involved in: -The supply of calcium to bones -Health of blood vessel walls; -Blood cholesterol and triglyceride levels; -Elasticity of the skin Climacteric change- Point in life (gradual process) where crucial changes occur; refers to the loss of reproductive activity, marked by menopause in women and reduction in testosterone production in men -Body composition slowly shifts in tandem with hormonal shifts. Over a 50-year period, the avg. man will lose 24 lbs. of muscle and replace it with 22 lbs. of fat! Age-Related Changes in Energy Expenditure --This "sarcopenia" (or muscle loss) is about 2-3% per decade. --Between ages 25 and 65 yo, physical work capacity (measured by VO2 max) declines by 5-10% per decade. --That also means that your 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 typically correspond to declines in PA and lean muscle mass. How do we control weight? Appropriate kcal + Physical activity Why did I show the picture of Arnold Schwarzenegger at the age of 20 (as “Mr. Universe”) and the picture of him roughly 50 years later? How did these pictures relate to changes in body composition during adulthood (esp. % body fat), BMI interpretations, physical work capacity (VO2max), and metabolic rate as well as energy requirements? Body Mass Index (kg/m2) Underweight: < 18.5 Normal weight: 18.5-24.9 Overweight: 25-29.9 Obese: > 30 1) Skinfold measurements 2) Underwater (hydrostatic) weighing 3) BOD POD (air displacement, which uses the same principle as hydrostatic weighing) 4) Bioelectrical Impedance Analysis (BIA) 5) DXA -most accurate = DXA Be familiar with the assessment methods and evaluations of % body fat, % desirable weight, and energy requirements with the various activity factors. How does %body fat for females differ from that of males with regard to what’s considered “essential” and “recommended”? Females usually carry more body fat because the baby Don’t worry about having to apply the Harris Benedict equation or the Mifflin St-Jeor equation (i.e., you don’t need to memorize the equations), but please know what these equations are used for (i.e., to calculate resting energy expenditure, or REE). Also know how the “activity factor (AF)” is used.  What are the three components that make up our total energy requirement? Basal metabolic rate, thermic effect of food, activity thermogenesis Why do we need fewer calories as we age and how has regulation of food intake changed? What are the AMDRs for adults? Muscle mass and physical activity decreases Review the specific Dietary Guidelines for Americans (DGAs), such as recommended amounts for protein, saturated fat, MUFAs, PUFAs, added sugar, fiber, vegetables, fruits, water, etc. These should be a review from HNFE 1004 and from chapter 1 of your current textbook, but they are particularly relevant for our “Adult Nutrition” unit. 0.8 g/kg per day protein 2--0-35% fat Less than 10% should be saturated fat 10-15% monounsaturated fat Polyunsaturated should be less than 10% Fiber should be 14g per 1000 kcals 2.5 cups of veggies 2 cups of fruits How does the limit for “added sugar” compare to the average amount consumed in this country; women: 5-6 tsp/d (100 kcal) men: 9 tsp/d (150 kcal) Added sugar should be less than 10% of calories, WHO recommends less than 5%, but we way exceed that -the average American consumes about 22.2 tsp (or 93.24 g); this is about 4x the recommended amt for women and 2.5x the recommended amt for men and the amount in one 12-oz. can of regular soda? 10 teaspoons of sugar or 39 grams What is the recommendation for water intake for adults and what are the other considerations related to beverage consumption for adults? Total Water AI for men = 3.7 liters (L) and for women = 2.7L Know the DRI for the nutrients that are particularly important for adults (and were also important during earlier stages of the human lifespan). Hint: If you look below that PP slide, you can read the description of the key functions of each of these micronutrients. Know the functions please as these will help you understand why the needs may change across the life span. Think about why there are differences in some of the nutrient needs (DRI) for adult males and females. What are the functions of these key micronutrients? Please study these DRIs with their Units. Vitamin A: F: 700 micrograms M: 900 micrograms - Bones, teeth, skin, tissues, vision Vitamin E: F: 15 mg M: 15 mg - Function: antioxidant that prevent damage to cell membranes and inhibits oxidation of LDL-C Vitamin C: F: 75 mg M: 90 mg - Function: antioxidant; protects cells from free radicals (oxidation); collagen synthesis Folate: F: 400 micrograms M: 400 micrograms - Function: red blood cell formation and cell growth (mitosis), prevents NTD Vitamin B12: F: 2.4 micrograms M: 2.4 micrograms - Function: works closely together with folate and is needed for DNA and RNA synthesis; needed for normal red blood cell formation and needed for the conversion of homocysteine (sulfur-containing AA) to methionine (EAA) Zinc: F: 8 mg M: 11 mg - Function: activation of many enzymes involved in the reproduction of proteins; component of insulin and many enzymes and needed for sperm health; growth and appetite, tase acuity -males need more because involved in sperm health and males utilize more protein than females Iron: F: 18 mg (after 50 yo) M: 8 mg - Function: transport oxygen to the cells as a component of hemoglobin, cognitive development -females require more iron due to menstruation; after age 50, may change again due to menopause Magnesium: F: 320 mg M: 420 mg - Function: activates hundreds of enzymes involved in energy metabolism (so men need more) and it is also a component of bones and teeth Chromium: F: 25 micrograms M: 35 micrograms - Function: normal utilization of glucose and fat -(men need more because they consume more energy, which means they have greater glucose and fat metabolism) Calcium: Both F and M 1000 mg - Function: Bones, teeth, blood clotting Vitamin D: F: 15 micrograms M: 15 micrograms - Function: help control and fight off infections and reduce inflammation, involved in building bone by helping body absorb calcium and phosphorus (fat soluble vitamin); helps with calcium absorption Know the basics about dietary supplements, phytoestrogens, vegetarian diets, and physical activity, which can all impact the nutritional status of adults. Supplements can be beneficial, but people should consult their doctors, they can also have fillers in them Chapter 17: Adult Nutrition – Conditions and Interventions Know some of the conditions/diseases related to obesity and which chronic disease is not. Think about the “obesity prevalence landscape” of the United States (in very general terms) and how much it has changed in just two generations (between 1985 and the last few years). This tells us that the causes of our obesity epidemic are not only rooted in genetics. Instead, they can be largely attributed to our changing food supply and other societal aspects that affect food-related behaviors and decisions. Think about some of the other concepts we discussed related to obesity (i.e., the two different types of obesity, the impact of epigenetic factors, different phenotypes, and the obesogenic environment). 1. breast cancer 2. endometrial cancer 3. insulin resistance 4. osteoarthritis 5. heart disease 6. metabolic syndrome 7. inflammatory disease 8. hypertension 9. type 2 diabetes 10. depression 11. sleep apnea 12. prostate cancer 13. gallbladder disease 14. colon cancer *obesity is associated with increased risk of almost all nutrition related chronic diseases except osteoporosis Be able to identify if someone might have metabolic syndrome based on several biomarkers and other assessments (keep in mind that any 3 out of the 5 metabolic aberrations need to exist for someone to be officially diagnosed with “metabolic syndrome”). Also know the approximate percentages related to the prevalence of metabolic syndrome in the US. Metabolic syndrome is strongly correlated with body weight. 1. Abdominal obesity (waist circum. ≥40 in men; ≥35 in women) 2. Elevated blood pressure (≥130/>85 mmHg ) 3. Insulin resistance: - elevated fasting blood glucose (>110 mg/dL) - elevated fasting plasma insulin levels (WHO) 4. Elevated blood triglycerides (>150 mg/dL) 5. Low blood HDL-C (