OS 206: Aging of the GI System and Nutrition Labels PDF

OS 206: ABDOMEN AND PELVIS AGING OF THE GI SYSTEM AND DECIPHERING NUTRITION LABELS UPCM 2029 | Dr. Carlos R. G. Cuaño | LU3 A.Y. 2024-2025 ○​ difficulty in swall...

OS 206: ABDOMEN AND PELVIS AGING OF THE GI SYSTEM AND DECIPHERING NUTRITION LABELS UPCM 2029 | Dr. Carlos R. G. Cuaño | LU3 A.Y. 2024-2025 ○​ difficulty in swallowing OUTLINE ○​ around 26.7% of people at the age of 76 and above has this Part I Part II ​ Increased risk of choking I.​ Aging VI.​ Deciphering Food Labels ​ Sensation of food stuck and throat II.​ Parts of the GI System VII.​ Nutrition Labels B.​ ESOPHAGUS and Aging A.​ Parts A.​ Mouth B.​ Labelling Terms GASTROESOPHAGEAL REFLUX DISEASE (GERD) B.​ Esophagus C.​ Interpretation and ​ Decrease in upper esophageal (UES) and lower esophageal C.​ Stomach Comparison (LES) pressure D.​ Small Intestine VIII.​ Making Healthy Choices ○​ Decreased in primary and secondary peristalsis E.​ Colon A.​ Sodium in Diet ○​ Hypertrophy of a skeletal muscle F.​ Liver B.​ Fibers in Diet ○​ Decrease of ganglion cells G.​ Pancreas C.​ Daily Values ○​ Increase muscles smooth muscle thickness H.​ Gallbladder IX.​ References ​ Increased reflux GERD III.​ Altered Signs and ○​ More common in elderly Symptoms ○​ Due to impaired motility, decrease in esophageal emptying A.​ Anorexia of Aging ​ More prone to reflux B.​ Dysphagia ○​ Decreased intra-abdominal lower esophageal length C.​ Diarrhea ○​ Increase in the hiatus hernia D.​ Constipation ​ Milder symptoms can mean more severe diseases E.​ Fecal Incontinence F.​ Fecal Impaction IV.​ Overview V.​ Review Questions PART I: AGING OF THE GI SYSTEM LEARNING OBJECTIVES 1.​ Discuss the physiologic changes of the aging gastrointestinal tract 2.​Explain how these changes affect the quality of life of the aging individual 3.​Explain the physiology of the diseases that result from these changes I.​ AGING ​ Aging ○​ Progressive and broadly predictable changes ○​ Not homogenous process, organs in the same person age at different rates Figure 1. Increase in Annual Incidence of GERD with Age ○​ Influenced by genetics, lifestyle and environment ○​ Danish Twin Study ​ Genetics - 25% ​ Environment - 50% ​ The older you get the more relevant genetics becomes ○​ Increased susceptibility to diseases ​ Homeostenosis ○​ Diminishing physiological reserves as one ages ○​ Recognized by Walter Cannon in the 1940s ○​ Leads to increased vulnerability to disease that occurs with aging ​ New GI complaints in otherwise healthy older adults are due to disease rather than to aging alone and therefore merit appropriate investigation and treatment ○​ Rule out pathologies before attributing it to age Figure 2. Balloon model for LES narrowing in GERD (L); Hiatal Hernia (R) II.​ PARTS OF THE GI SYSTEM AND AGING C.​ STOMACH A.​ MOUTH ​ Oral mucosa epithelial lining thins Table 1. CHANGES IN THE STOMACH DUE TO AGING AND ITS RESULTS ​ Gum recession and increase of risk of tooth decay STOMACH RESULT ○​ Maxillary and Mandibular bone shrink ○​ Reduction in bone calcium leads to erosion of the tooth sockets ​ ↓ Capacity of gastric reposal to ○​ Decreased Power of Mastication resist damage ​ More prone to NSAID induced ​ Xerostomia ​ ↓ Mucosal blood flow, mucosal damage and ulcers ○​ Small decrease in acinar cells prostaglandin, bicarbonate, ○​ 50% decrease maximal salivary secretion from parotid glands mucus secretion ○​ Accessory glands production is unchanged ​ Intrinsic Factor secretion ○​ Can also be contributed to use of drugs ​ Pernicious Anemia is rare maintained ​ Diuretics ​ Antihypertensives ​ Slow gastric emptying: ​ Prolonged long gastric ​ Antibiotics ○​ due to the number of volume retention ​ Bronchodilators of interstitial cells of Cajal ​ Increase meal induced fullness, ​ Some antidepressants Bodies decrease over 10% and satiety ​ Decreased in taste recognition and detection of sweet, sour, predicate ○​ Leads to anorexia and salty and bitter ○​ Altered fundic relaxation weight loss ○​ Decrease in the number and density of taste buds ○​ Decrease number of taste cells PEPTIC ULCER DISEASE AND AGING ​ Ultimately, all of this leads to disinterest in food ​ Prostaglandins ○​ Anorexia ○​ inflammation, pain chemical ○​ Malnourishment ○​ Inhibited by nonsteroidal anti-inflammatories (NSAIDS) ○​ Weight loss ○​ Lipid with hormone like properties ○​ Consume less dietary fiber → constipation ○​ Promotes mucus and bicarbonate secretion and mucosal blood flow SWALLOWING ○​ Inhibits acid secretion ​ Muscular contractions that initiate swallowing slowdown which ○​ Increases resistance of surface epithelial cells which helps leads to an increase of pharyngeal transit time protect the gastric mucosa ​ Dysphagia ​ As you age with drugs (NSAIDS) and physiological changes that Trans 5 TG4: Batac, Bathan, Bermudez, Binangbang, Bisquera, Buhion, Busog TH: Marquez 1 of 9  happen, we become more prone to mucosal damage and ulcers overgrowth of bacteria to occur ​ True diverticula [UPCM2026] ○​ All layers of the bowel are involved ​ False diverticula ○​ Only includes serosa and mucosa as affected areas ○​ Prone to microperforations ​ Microperforations can cause infection/inflammation (i.e. diverticulitis) ​ Can cause sitophobia (Fear of eating) ​ Severe inflammation (macroperforation) can cause diverticula to rupture ○​ Fecal material may leak into the abdomen and cause a medical emergency such as adhesions and peritonitis F.​ LIVER Figure 3. Protective and Aggressive Factors of PUD in Aging ​ Liver becomes brown due to ↑ in lipofuscin (a brown pigment) D.​ SMALL INTESTINE ○​ metabolic residue of lipids and proteins ​ Pretty well preserved ○​ no clinical significance ​ Moderate villus atrophy and coarsening of mucosa ​ Liver becomes more fibrotic with age: ​ Normal ○​ ↓ hepatic volume by 17-28% between ages 40-65 ○​ Transit time compared to esophagus and stomach ○​ ↓ hepatic weight by 25% between ages 20-75 in men and women ○​ Small bowel absorption for most of the nutrients remains intact ​ Altered drug clearance except in disease and medications ○​ Reductions in phase I reactions (e.g., oxidation, hydrolysis, ○​ Protein digestion and assimilation and fat absorption reduction), first-pass hepatic metabolism, and serum ​ Decreased albumin-binding capacity ○​ Splanchnic blood flow ○​ Phase II reactions (e.g., glucorinidation, sulfation) are ○​ Jejunal lactase activity unaffected ​ deficiency is tied with lactose malabsorption tied with east Biotransformation of Drugs [UPCM 2027] asian ​ Phase 1 Reactions ○​ Absorption of Zinc and Calcium with age ○​ Oxidation, reduction or hydrolysis convert parent drug into ○​ Absorption of Vitamin D with reduction in Vitamin D receptor and more polar metabolites responsiveness ○​ Rate of Phase 1 reactions decreases with age ​ Filipinos are generally Vitamin D deficient ​ Phase 2 Reactions E.​ COLON ○​ Conjugation of parent drug or metabolite with an additional substrate (e.g. glucuronic acid, sulfate), achieving the same Table 2. CHANGES IN THE COLON DUE TO AGING AND ITS RESULTS result COLON RESULT ○​ Rate of Phase 2 reactions remains unchanged ○​ If two drugs have the same effect, it is best to choose the drug ​ Atrophy of mucosa that undergoes Phase 2 reaction, particularly in elderly patients muscularis propria ​ Response to stress ​ ↑ in fibrosis and elastin ○​ Decreases with age ​ Proliferating cells ○​ Hepatotoxic drugs cause more severe injuries in livers of older ​ Diverticulosis ​ Abnormal appearing myenteric persons ganglia ​ Hepatic regeneration is delayed but not greatly impaired with ​ ↓ Muscle strength age *↑ muscle layers ​ Reduced perception of LIPOFUSCIN anorectal distention ​ Constipation ​ Pale golden brown finely granular pigment in nearly all ​ delay in colonic transit?? hepatocytes marked by arrow in figure below ​ “Wear and tear” pigment from the accumulation of ​ Increased prevalence of ​ Abdominal pain autophagolysosomes atherosclerosis -> ischemic ​ Diarrhea ​ No real pathologic importance colitis ​ Hematochezia ​ Constipation (for 25% of 65 ​ ↓ Colonic propulsive motility years above) ​ ↓ Myenteric plexus motility ​ ↓ ICC ​ Constipation ​ Intrinsic sensory neurons degenerate ​ Older women → decrease in anal sphincter tone than men ​ Fecal incontinence ​ thinning in external anal sphincter ​ ↓rectal compliance and Figure 4. Lipofuscin sensation and perineal laxity ​ Internal anal sphincter G.​ PANCREAS ​ Fecal incontinence in women develops fibrofatty degeneration and increased Table 3. CHANGES IN THE PANCREAS DUE TO AGING AND ITS RESULTS thickness PANCREAS RESULT ​ Failure of evacuation due to ​ ↑ in the diameter of the ​ No clinical significance but can insufficient opening of the pancreatic duct lead to fatty pancreas rectoanal angle ​ Constipation in elderly women ○​ Abnormal if >3 mm especially in women ​ ↑perineal descent compared with younger women ​ ↓ in overall weight, duct hyperplasia, and lobular fibrosis DEFECATION ​ ↓ in amylase, trypsin, lipase, ​ No effect on fat, CHO, CHON ​ ↓ muscle wall strength and bicarbonate secretion absorption ​ ↓ muscle wall compliance ​ ↑ intraabdominal pressure required for stool excretion ​ It is a very important organ (much like small intestines), changes are minimal/not of clinical importance DIVERTICULAR DISEASE ○​ Because our body needs to maintain proper functioning ​ Development of small bulging pouches in the GIT ​ Even though there is decrease in secretions, high supply of these ○​ Most commonly in the colon substances in body does not cause significant effect on ○​ Due to increased pressure in defecation of the elderly digestion ​ Perforating arteries in colon are considered “weakspot” ○​ Consumption of low-fiber diets commonly increases pressure in H.​ GALLBLADDER the colon Table 4. CHANGES IN THE GALLBLADDER DUE TO AGING AND ITS RESULTS ​ Increased pressure pushes the mucosa and submucosa layers to form a small bulging pouch called a diverticulum GALLBLADDER RESULT ​ Foods/feces can fill up diverticulum ​ ↓ sensitivity to CCK ​ Lodging of feces in diverticulum make it easier for ​ ↑ in gallstone prevalence OS 206 Aging of the GI System and Deciphering Nutrition Labels 2 of 9 ​ ↑ cholesterol in bile 30% of women and 20% of men by age 70 ​ No change in GB emptying, 40% of women by age 80 fasting, and non-fasting volumes ​ ↑ cholesterol in bile ​ ↑ bactobilia ​ ↑ deconjugation of bile salt pigments ​ ↑ choledocholithiasis after emergency cholecystectomy 50% ​ ↑ CBD diameter even in the absence of pathology III.​ SIGNS AND SYMPTOMS OF GI AGING A.​ ANOREXIA OF AGING ​ Physiologic decline in food intake in the elderly ​ Balance decreased physical activity and resting metabolic rate with Figure 21. Enlarged aorta causing dysphagia aortica aging ​ Contributing factors (reasons for occurrence) C.​ DIARRHEA ○​ Decreased salivation ​ Dietetic indiscretion ​ decreased saliva production makes chewing and swallowing ○​ Food intolerance - consumption of large amounts of fruits or difficult beans can trigger diarrhea. ○​ Altered sense of smell and taste ​ Medication ○​ Dental disorders ○​ Mg2+ antacids - can induce diarrhea as a side effect. ○​ Memory loss ​ Fear of constipation ​ elderly individuals may forget they have already eaten or may ○​ e.g. tendency to immediately drink laxatives not remember to eat regularly. ​ Increased susceptibility in certain populations ○​ Depression ○​ Individuals using proton-pump inhibitors (PPIs) are more prone ​ mental health challenges can lead to reduced interest in food to infectious diarrhea. and eating. ○​ e.g. Hypochlorhydria and achlorhydria ○​ Social changes ○​ Risk factors: pernicious anemia or gastric acid-suppressive drugs ​ Isolation or loss of loved ones can decrease the motivation to ​ Luminal stasis prepare and consume meals. ○​ Conditions like motility disorders or previous gastrointestinal ○​ Polypharmacy surgeries can lead to stasis, contributing to diarrhea. ​ multiple medications can interact and affect appetite or cause ○​ Decreased mucosal immune function may also play a role. nausea, leading to reduced food intake. ​ Ischemia ○​ Chronic conditions ○​ Mesenteric thrombosis or ischemic colitis ​ health issues like hypertension or heart failure can affect ​ Impaired blood flow in the gut or splanchnic circulation, metabolism and appetite. commonly due to atherosclerosis ○​ Difficulty swallowing ​ Reduces the blood supply required for optimal GI tract function ​ Age-related issues with swallowing (dysphagia) can make eating more difficult and reduce food intake D.​ CONSTIPATION ​ Manifestation ​ Most frequent complaint (prevalence 24-37%) ○​ Increased satiety signals ​ Causes ​ CCK - rises with fasting and lipid intake in the duodenum, ○​ Immobility signaling fullness. ​ e.g., People with chronic congestive heart failure, chronic renal ​ Leptin - Hormone indicating body fat levels and promoting disease, rheumatoid arthritis, fractures, etc. [2028 Trans] long-term satiety. ​ “Ang inyong bituka ay kasing tamad ninyo.”: If you don’t move, ​ GLP-2 - released from the intestines after eating, this your GI tract also won’t move as much. hormone regulates food intake. ○​ Perineal problems ○​ Decreased: ○​ Medications ​ Appetite and food consumption ​ e.g., aluminum antacids ​ Feeding drive ​ ↓ Opioid (dynorphin) and possibly neuropeptide Y and nitric Mnemonic from Dr. Cuaño: oxide ​ ALuminum = ALa tae → constipation ​ Decreased stomach fundus compliance ​ MAGnesium = MAGtatae → diarrhea ​ Ghrelin: Lower by ⅓ in older adults, reducing hunger signals. ○​ Decreased fluid/caloric intake ​ Increased feeling of satiety ○​ Elevated toilet seats B.​ DYSPHAGIA ​ Harder to produce intra-abdominal pressure in short and older ​ Esophageal motility abnormalities people ​ Extrinsic compression by aorta BRISTOL STOOL CHART ○​ Dysphagia aortica ​ Mechanical obstruction of the esophagus due to compression from an abnormally dilated aorta. ​ More common in older women, particularly those with a short stature, high blood pressure, and spinal curvature (kyphosis). ​ Dysphagia lusoria ○​ Resulting from congenital vascular disorders, such as an aberrant right subclavian artery ○​ compresses the esophagus, leading to swallowing difficulties ​ CV dysphagia ○​ Caused by enlarged left atrium ○​ Impinge on the esophagus and lead to mechanical obstruction, making swallowing difficult. Figure 5. Bristol Stool Chart E.​ FECAL INCONTINENCE ​ Loss of voluntary control of defecation ○​ 5% of the general population are affected ○​ 50% of institutionalized patients ​ Humiliating regression in bodily function ○​ Causes anxiety, fear, embarrassment, and reclusiveness ○​ Severely impair elderly person’s activity and socialization ​ May occur most commonly over the age of 65[2026 Trans] ​ Causes OS 206 Aging of the GI System and Deciphering Nutrition Labels 3 of 9  ○​ Anal sphincter dysfunction ○​ Pelvic floor abnormalities ○​ Limited mobility or mental capacity who present with an alteration in bowel habit (reduced frequency, new-onset diarrhea, incontinence) ○​ Fecal impaction: “Paradoxical Diarrhea” ​ “Paradoxical” in a sense that: ​ Constant constipation causes build-up of hard, solid stool ​ Only liquid feces comes out ⇒ “diarrhea” Figure 8. Fecal impaction of 49/M with paraplegia and renal insufficiency TREATMENT ​ Dietary Changes and Approaches ○​ Adequate hydration, especially in elderly persons who use diuretics ○​ Food with high residual fiber ​ Bran and other whole grains, vegetables, nuts ​ Psyllium Figure 6. Fecal impaction and overflow incontinence ​ Behavioral Changes OVERFLOW INCONTINENCE ○​ Exercise → strongly stimulates defecation and helps strengthen the abdominal muscles that aid defecation ​ Leakage of stool around obstructing feces ​ Make sure it is age-appropriate On overflow incontinence [2028 Trans]: ​ Judicious use of laxatives and enemas ​ Liquid feces from proximal intestines pass through the sides of ○​ Plain tap water enemas or sodium phosphate and biphosphate the impacted feces enemas can be used ​ Liquid stools from the right side (ascending colon) passes at the ○​ Soapsuds enemas, which produce mucosal damage and side of the solidified stools on the left side (descending colon) cramping, should be avoided ○​ Might be mistaken as diarrhea since only liquid or soft stools For SEVERE impaction [from Dr. Cuaño and Cleveland Clinic, 2022]: are passed by the patient ​ Physical assisted removal: A medical professional uses a gloved ​ Rectal exam is a recommended procedure for patients with finger to manually remove poop from your rectum (digital chronic illnesses and diarrhea to identify if the patient has disimpaction) or perform an abdominal massage to target the overflow incontinence and not fecal incontinence stuck stool ​ Internal anal sphincter (IAS) is primarily responsible for maintaining continence IV.​ OVERVIEW ○​ External anal sphincter only helps the IAS ○​ Injury to the IAS (e.g. due to giving birth) might result into the development of fecal incontinence F.​ FECAL IMPACTION ​ Increased rectal compliance and impaired rectal sensation ○​ Larger rectal volumes needed to elicit desire to defecate ​ Causes ○​ Patient’s misperceptions about normal bowel habits ​ e.g. Patients immediately taking antidiarrheals when they have soft stools ○​ Metabolic, muscular, or neurological disease ​ e.g. Stroke patients, diabetes that is poorly controlled ○​ Low rectal or anal mass ○​ Metabolic conditions especially hypothyroidism ​ Severe fecal impaction may cause: ○​ Abdominal distention ○​ No bowel movement for a week Figure 9. Overview of age-related changes to the GI tract V.​ REVIEW QUESTIONS (2028) ​ Aging is associated with many changes of the GI system. Answer: ○​ A, if aging increases ○​ B, if aging decreases ○​ C, if aging has no effect 1.​ Tertiary esophageal peristalsis 2.​ Capacity of gastric mucosa to resist damage 3.​ Diverticulosis 4.​ Calcium absorption in the intestines 5.​ Salivary secretion 6.​ Ghrelin secretion 7.​ Fat absorption Answer Key: 1) A, 2) B, 3) A, 4) B, 5) B, 6) B, 7) C Figure 7. Fecal impaction PART II: DECIPHERING NUTRITION LABELS Case: 49 year old man with paraplegia [2028 Trans] VI.​ DECIPHERING FOOD LABELS ​ Patient developed severe constipation ​ Obesity is a pandemic ○​ Area highlighted (Figure 8) represents collection of stools ○​ Countries with initially lower BMI now have high BMI due to the ​ When neglected, caretakers may not notice that the patient has adoption of Western diet not been defecating for a long time already ​ Even if you give the patient laxatives, the intestines won’t be Study: Japanese in Japan vs Japanese in the U.S. [from Dr. emptied Cuaño] ​ Japanese living in the US have a much worse lipid profile compared to those living in Japan ​ Cause: Adoption of Western diet ○​ Overweight kids become overweight adults ​ Food and Nutrition Research Institute (FNRI) Expanded OS 206 Aging of the GI System and Deciphering Nutrition Labels 4 of 9  Nationwide Nutrition Survey (ENNS) (2018) ○​ 100 Calories is moderate ○​ Adults: 28.8% overweight and 9.6% obese ○​ 400 Calories or more is high ○​ Children (5-10 years old): 11.6% overweight and obese Table. Nutrition Terms VII.​ NUTRITION LABELS TYPE FAT CONTENT ​ Also known as Nutrition Facts Label or Food Label ​ Nutrients from one serving of the food Low calorie 40 calories or less per serving ​ List of food ingredients from highest to lowest 20 milligrams or less and 2 grams or less Low cholesterol of saturated fat per serving At least 25% less of the specified nutrient Reduced or calories than the usual product Non-Fat ≤0.2% Provides at least 10 to 19% of the Daily Good source of Value of a particular vitamin or nutrient per serving Provides at least 20% or more of the Daily Excellent source of Value of a particular vitamin or nutrient per serving Calorie free Less than five calories per serving Less than ½ gram of fat or sugar per Fat free/sugar free serving 140 milligrams or less of sodium per Low sodium serving Provides 20% or more of the Daily Value of High in a specified nutrient per serving NUTRIENTS TO LIMIT (L) Figure 10. Nutrition food label guide ​ Avoid buying products with trans fat ○​ Hydrogenated fats prolong product shelf life ​ Watch out also for ○​ Cholesterol ○​ Sodium Table 5. NUTRIENTS THAT MUST BE LIMITED Nutrients % Daily Value Total fat 12g 18% Saturated Fat 3g 15% Trans Fat 3g Cholesterol 30mg 10% Sodium 470mg 20% Total Carbohydrate 31g 10% Cholesterol ​ Must be less than or equal to 300 mg ​ As 2,000 calories is the standard, the amount must be adjusted to Figure 11. Nutrition Facts one’s caloric requirement ​ Consider your daily calorie goals ○​ Those with heart disease should also reduce cholesterol intake ○​ The same goes for the Daily Value listed on food labels Table 6. CHOLESTEROL CONTENT IN COMMON FOOD ITEMS ○​ This percentage, which is based on a 2,000-calorie-a-day diet, helps you gauge how much of a specific nutrient one serving of Food Cholesterol (mg) food contains, compared with recommendations for the whole day. Egg, large, boiled 186-210 ​ 5% or less = low Quail egg 26 ​ 20% or more = high ○​ Look for foods with the following Duck egg 620 ​ fats, cholesterol and sodium on the low end of the Daily Value Shrimps (100g) 189 ​ fiber, vitamins and minerals on the high end Crab 53 A.​ PARTS Oysters 71 SERVING SIZE (S) ​ Exceeding 100% daily value of 300mg ​ Serving size and number of servings per container/package ○​ Two large boiled eggs (of 200 mg cholesterol) are already worth ○​ Need to compute the actual serving size, and consequently, 400 mg cholesterol the rest of the nutritional information based on the number of ○​ 4 pieces of kwek kwek servings ○​ Actual serving size = (servings per container) x (serving size) MORE OF THESE NUTRIENTS (M) ○​ E..g., 456g = 228g ​ Food items with ≥ 20% of these nutrients make it an excellent source of that nutrient ○​ Food items are considered a good source of these nutrients if their corresponding value ranges from 10-19% Table 7. NUTRIENTS THAT MUST BE LIMITED Nutrients % Daily Value Remarks Figure 12. Serving Size Dietary Fiber 0g 0% 5% or less is low CALORIES (C) ​ Check Calories and note the (1) calories per serving and (2) Sugars 5g calories from fat Proteins 5g Vitamin A 4% Vitamin C 2% 20% or more is high Figure 13.Calories in nutrition label ​ General Guide to Calories Calcium 20% ○​ 40 Calories is low OS 206 Aging of the GI System and Deciphering Nutrition Labels 5 of 9  Figure 14. Ingredient list with indicated percentages Iron 4% ​ The list would also include information on allergen content ​ Low is 5% or less ○​ Aim low in saturated fat, trans fat, cholesterol and sodium ​ High is 20% or more ○​ Aim high in vitamins, minerals and fiber ​ Eat more fiber, potassium, vitamin D, calcium and iron to maintain good health and help reduce your risk of certain health problems such as osteoporosis and anemia ○​ Choose more fruits and vegetables to get more of these nutrients ​ Remember to aim high for the percentage DV of these nutrients FOOTNOTE (F) ​ Percent daily values may be based on a 2,000 calorie diet or a 2,500 calorie diet Figure 15. Ingredient list containing allergens ○​ DVs are recommended levels of intakes ○​ Food item has a high sugar content as indicated by high fructose ○​ 20g of sat fat and 65g of total fat would be their 100% daily value corn syrup, corn syrup, honey, and dextrose and must be avoided ○​ Recommended values by public health experts by diabetics ​ Asians need lower calories ○​ Moreso Asian women B.​ LABELLING TERMS ​ As 2,000 calories is the standard, the amount must be adjusted to one’s caloric requirement FATS ​ Note how the DVs for some nutrients change, while others (for Table 9. LABELLING TERMS FOR FAT cholesterol and sodium) remain the same for both calorie amounts. TERM DEFINITION Table 8. NUTRIENTS THAT MUST BE LIMITED