Adult Nutrition Chapter 8 PDF

Chapter 8 Adult Nutrition Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction Segments of adulthood – Early adulthood – Midlife...

Chapter 8 Adult Nutrition Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction Segments of adulthood – Early adulthood – Midlife – Later adulthood Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction (cont’d.) Early adulthood: 20-39 years – Becoming independent and leaving the parental home – Planning, buying, and preparing food are newly developing skills – Renewed interest in nutrition “for the kids’ sake” Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction (cont’d.) Midlife: forties – Active family responsibilities – Managing schedules and meals becomes a challenge – Reviewing life’s accomplishments – Recognition of one’s mortality Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction (cont’d.) “Sandwich” generation: fifties – Many are multigenerational caregivers Juggle roles of caring for children and aging parents, all while maintaining a career – Health is often an added concern Chronic disease Management of identified risk factors to prevent diseases Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction (cont’d.) Later adulthood: sixty plus – Transition to retirement – More leisure time – Greater attention to physical activity and nutrition – Added significance for food choices and lifestyle factors, especially for those with chronic disease Copyright © 2017 Cengage Learning. All Rights Reserved.  Importance of Nutrition Between the ages 20 and 64 is a time when the future course of health and wellness are influenced by: – Diet – Physical activity – Smoking – Body weight Copyright © 2017 Cengage Learning. All Rights Reserved.  Importance of Nutrition (cont’d.) Nutrition and exercise – Among the main lifestyle factors that reduce onset and severity of five out of ten leading causes of death Heart disease Stroke Diabetes Some cancers Liver disease Copyright © 2017 Cengage Learning. All Rights Reserved.  Importance of Nutrition (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Health Disparities Among Groups of Adults Some population groups have a higher prevalence of chronic diseases than others – Some have a genetic disposition for certain diseases Genetics, lifestyle, and environment interact Copyright © 2017 Cengage Learning. All Rights Reserved.  Health Disparities Among Groups of Adults Copyright © 2017 Cengage Learning. All Rights Reserved.  Physiological Changes of Adulthood Growing stops by the twenties – Bone density continues until age 30 – Muscular strength peaks around 25 to 30 years of age – Dexterity and flexibility decline – Other body composition changes slowly occur in tandem with hormonal shifts Copyright © 2017 Cengage Learning. All Rights Reserved.  Hormonal and Climacteric Changes Women – Decline of estrogen leads to menopause – Increase in abdominal fat – Increase in risk of cardiovascular disease – Accelerated loss of bone mass Men – Gradual decline in testosterone level and muscle mass Copyright © 2017 Cengage Learning. All Rights Reserved.  Body Composition Changes in Adults Bone – Bone loss begins around age 40 Adiposity – Positive energy balance resulting in increase in weight and adiposity Gut microbiome – Each individual has a gut microbiota “fingerprint” that is relatively stable, but shifts can shift due to factors such as diet, illness, and medication Copyright © 2017 Cengage Learning. All Rights Reserved.  Continuum of Nutritional Health Nutritional health can be viewed as a continuum – “Healthy” and resilient state to terminal state Body systems shut down and life ceases Copyright © 2017 Cengage Learning. All Rights Reserved.  States of Nutritional Health Resilient and “healthy” – Metabolic systems are in homeostasis Organs are functioning at optimal level – Nutritional guidance Encourage adequate intake Not too much, not too little Mantra: “moderation, variety, and balance” Copyright © 2017 Cengage Learning. All Rights Reserved.  States of Nutritional Health (cont’d.) Altered substrate availability – 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 High sugar intake , high blood sugar occasionally Copyright © 2017 Cengage Learning. All Rights Reserved.  States of Nutritional Health (cont’d.) Nonspecific signs and symptoms – Insufficient or excessive intake of nutrients or energy leads to observable changes Well-recognized risk factors for chronic disease – Dietary guidance: target specific risk factors and observable signs and symptoms Measure and monitor for progress to halt or reverse risk factors for disease age, family history, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic change Represents pre-diabetes, with early signs of high blood sugar and initial symptoms *Blood sugar levels are higher than normal but not yet in the diabetic range. Early signs might include fatigue and increased thirst. Copyright © 2017 Cengage Learning. All Rights Reserved.  States of Nutritional Health (cont’d.) Clinical condition – Genetic predisposition, interacting with dietary components and environmental factors, influence whether and when the clinical condition develops Change is difficult Intensive intervention may be needed (e.g., medical nutrition therapy or therapeutic behavior-change programs) evidence-based medical approach to treating certain chronic conditions through the use of an individually-tailored nutrition plan Early type 2 diabetes, where blood sugar levels are consistently high. *Symptoms may include frequent urination, blurred vision, and increased hunger Copyright © 2017 Cengage Learning. All Rights Reserved.  States of Nutritional Health (cont’d.) Chronic condition – Altered metabolism and structural changes in tissues become permanent and irreversible Examples: structural damage to coronary arteries, invasive and metastatic cancer, loss of kidney function, or blindness – Intervention is aimed at managing the condition Prolonged high blood sugar begins to affect organs and tissues. Severe diabetes with complications such as neuropathy, nephropathy, and retinopathy. *Symptoms include slow-healing wounds and recurrent infections. Management becomes complex and critical. Copyright © 2017 Cengage Learning. All Rights Reserved.  States of Nutritional Health (cont’d.) Terminal illness and death – Final stage in the continuum – Complications advance – Body systems shut down – Life ceases Minimal response to interventions. *Severe complications from diabetes, including heart disease, kidney failure, and severe nerve damage. Copyright © 2017 Cengage Learning. All Rights Reserved.  Energy Recommendations Energy requirements – Amount of dietary energy intake needed to be consumed by individuals to sustain stable body weight Consistent with long-term good health that would allow for adequate levels of physical activity to maintain social, cultural, and economic activity Copyright © 2017 Cengage Learning. All Rights Reserved.  Energy Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Age-Related Changes in Energy Expenditure Metabolic rate and energy expenditure begin to decline in early adulthood – About 2.9 percent for men and 2.0 percent for women per decade Reductions generally correspond to declines in physical activity and lean muscle mass Copyright © 2017 Cengage Learning. All Rights Reserved.  Estimating Energy Needs in Adults Energy needs: based on basal metabolic rate, thermic effect of food, and activity thermogenesis – Basil metabolic rate (BMR) 60 to 75 percent for involuntary processes – Thermic effect of food (TEF) About 10 percent needed for food metabolism – Activity thermogenesis 20-40 percent of total energy needs Copyright © 2017 Cengage Learning. All Rights Reserved.  Estimating Energy Needs in Adults Copyright © 2017 Cengage Learning. All Rights Reserved.  Estimating Energy Needs in Adults Copyright © 2017 Cengage Learning. All Rights Reserved.  Energy Adjustments for Weight Change 1 pound of body fat (¬454g) is approximately equal to 3500 calories – To lose one pound a week, an adult would need to create a negative balance of 500 calories per day A combination of decreased intake and increased activity is one approach to use Copyright © 2017 Cengage Learning. All Rights Reserved.  Energy Balance Adults need to pay attention to the balance between energy in and energy out – Reduction of total energy intake enhances weight loss regardless of macro diet composition Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations Macro and micro nutrient recommendations – Macronutrients: 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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrient Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Risk Nutrients Fiber – Decreases diet energy density – High-fiber diet is linked with lower body weight and less weight gain overtime – Forms: viscous, fermentable, and functional Calcium and vitamin D – Low vitamin D intake is associated with decreased calcium bioavailability Copyright © 2017 Cengage Learning. All Rights Reserved.  Risk Nutrients (cont’d.) Vitamin A and vitamin E – Fat-soluble vitamins with strong antioxidant functions Choline – Deficiency has been shown to cause fatty liver and muscle deterioration Potassium and sodium – High sodium decreases vasodilation and raises blood pressure, and potassium increases vasodilation Copyright © 2017 Cengage Learning. All Rights Reserved.  Risk Nutrients (cont’d.) Magnesium – Deficit elicits a calcium-activated inflammatory cascade Iron – Low dietary intake leads to depletion of iron stores, reduced synthesis of hemoglobin, and iron-deficiency anemia with decreased oxygen transport to tissues Copyright © 2017 Cengage Learning. All Rights Reserved.  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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Adults (cont’d.) Dietary guidance systems – Voluntary health organizations make additional science-based dietary recommendations American Cancer Society: Nutrition and Physical Activity Guidelines American Heart Association: Diet and Lifestyle Recommendations Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Adults (cont’d.) Focal points of dietary guidance systems – Increasing consumption of fruits, vegetables, fiber, and low-fat dairy products – Limiting saturated and trans fat intake – Avoiding processes meats – Keeping sugar and sodium intake low – Getting regular physical activity – Balancing energy intake with expenditure Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Adults (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Adults (cont’d.) Water intake recommendations – Men: 3.7 liters – Women: 2.7 liters Beverage intake recommendations – Choose water as the preferred beverage: three to five 12-ounce containers Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Adults (cont’d.) Caffeine and coffee intake – Contributes to daily total water intake – Some adverse effects with high doses Alcoholic beverages – Psychoactive drug with potential for abuse – Increases cancer risks Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Adults (cont’d.) Dietary supplements and functional foods – Vitamins, minerals, amino acids, herbal and botanical supplements, enzymes, prebiotics, and probiotics – Sometimes needed to assure nutritional adequacy Pregnancy Certain illness Low calorie or nutrient restricted diets Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary Recommendations for Adults (cont’d.) Functional foods – Food products or ingredients that have a physiological benefit beyond the nutritional value provided Ergogenic products to enhance physical performance Prebiotics and probiotics for gut health Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations Healthy eating and increased physical activity are the featured duo for combating obesity – Any physical activity is better than none – Physical activity helps to manage weight and reduce disease risk factors Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations (cont’d.) Guidelines for physical activity Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations (cont’d.) Promotion of physical activity – Personal, social, and environmental factors influence the degree to which physical activity is a routine part of lifestyle Active living movement: private businesses, nonprofit organizations, and government sectors collaborating to reduce sedentary lifestyles Copyright © 2017 Cengage Learning. All Rights Reserved.  Physical Activity Recommendations (cont’d.) Physical activity, body composition, and metabolic change – Regular physical activity leads to changes in body composition with reduced fat mass and increased lean mass Diet and physical activity – Healthy adults who exercise regularly and follow a healthful diet don’t need dietary modifications to support physical activity Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrition Intervention for Risk Reduction Many strategies are used to promote nutritional health – Individual, client-centered counseling – Multicomponent programs – Policy and system changes A model health-promotion program – “Sisters Together: Move More, Eat Better” Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrition Intervention for Risk Reduction (cont’d.) Public food and nutrition programs – Government extension programs – Second Harvest food bank – Soup kitchens and shelters for homeless – Meals-on-Wheels Copyright © 2017 Cengage Learning. All Rights Reserved.  Nutrition Intervention for Risk Reduction (cont’d.) Putting it all together – Adults need access to a variety of healthful foods, knowledge to guide food choices, and positive attitudes about food and eating, balanced with discipline – Follow the principles of variety, moderation, and balance in choosing a diet Copyright © 2017 Cengage Learning. All Rights Reserved.  Adult Nutrition: Conditions and Interventions Copyright © 2017 Cengage Learning. All Rights Reserved.  Introduction About half of adults will die from one or more nutrition-related chronic disease – Obesity, heart disease, diabetes, metS and cancer Development and progression of chronic diseases – Significantly impact quality and length of life – Nutrition plays an important role in primary and secondary prevention Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity Prevalence of obesity and overweight – Over one-third of U.S. adults are obese Another third are overweight Etiology of obesity – Not simply a matter of intake exceeding output Complex and chronic conditions, stemming from numerous interacting factors Metabolic obesity and hedonic obesity Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Effects of obesity – Increased risk for pathological conditions in most organs of the body Rises as degree of excess weight rises Diabetes mellitus, insulin resistance, dyslipidemia, hypertension, atherosclerosis etc – Life expectancy is shortened by six to 19 years, depending on severity Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Screening and assessment – BMI for classification of obesity and associated risks Correlated with total body fat and calculated from height and weight – Waist circumference for central adiposity Visceral fat, recognized as a potbelly or apple shape Highly correlated with metabolic abnormalities and chronic diseases Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Weight change since young adulthood – Modest amount of gain is significantly associated with increased risk and earlier onset of chronic disease 11–19 kg gain is associated with a twofold increase in risk Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Nutrition assessment – Used to understand overweight experience, current eating and activity patterns, psychosocial and medical factors, motivation, readiness to change, and goals – Several factors contribute to understanding the motivation to engage in a weight-loss program Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Intervention in obesity and overweight – Relatively small amounts of weight loss (3 to 5 to 10 percent of body weight) can reduce or prevent obesity health risks Comprehensive weight management program – Needed for successful weight loss, including diet, physical activity and behavior therapy Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Weight loss goals – Prevent further weight gain – Reduce body weight – Maintain a lower body weight for the long term Medical nutrition therapy for weight management – Reducing caloric intake – Meal replacements low-calorie diet in which one or two full calorie meals daily are replaced with a low-calorie drink or bar that usually has an energy content of no more than 1 MJ = 239 kcal approx Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Cognitive behavioral therapy for weight management – Cognitive restructuring and stimulus control Recognize and replace automatic and irrational thoughts and beliefs Increase awareness and control of cues associated with eating psychological therapy that is used to treat many different problems, ranging from anxiety to weight loss. CBT should not be used by itself to lose weight, but rather it is used to support lifestyle changes Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Components of weight management based on cognitive behavioral therapy – Realistic goals – Caloric deficit – Meal plan – Skill development – Problem-solving techniques – Self-monitoring and management Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Components of weight management based on cognitive behavioral therapy – Cognitive restructuring – Stress management – Support system – Regular exercise – Maintenance – Long-term effectiveness Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Physical activity for weight management – Contributes to energy deficit – 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 – Physical activity reduces diabetes and cardiovascular risk Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) The challenge 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 – Successful weight loss maintenance Use more behavioral strategies – Consistently control calorie intake – Exercise more often and strenuously – Track weight – Eat breakfast Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) Pharmocotherapy for weight loss – Comorbidities and risk factors may warrant use of weight loss drugs – 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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Overweight and Obesity (cont’d.) 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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease Diseases related to the heart and blood vessels – Usually associated with atherosclerosis Coronary heart disease (CHD) Cerebral vascular disease (CVD) Blood vessels in the legs (PAD) – Hyperlipidema and hypertension Important factors in CVD progression Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Prevalence of CVD – Over 83 million adults – Men develop at younger age Women catch up after menopause – Racial and ethnic differences occur – CHD is the number two cause of death in U.S. adults aged 34-64 Progress is being made in reducing the deaths Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Etiology of atherosclerosis – Fibrous plaque formation begins when fatty deposits become part of tissues that form over injured arterial wall cells Physiological effects of atherosclerosis – Atherosclerosis reduces blood flow, vessels lose flexibility, and the heart has to work harder leading to higher blood pressure Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Risk factors for CVD – Dyslipidemia – High blood pressure – Lifestyle factors of diet or physical inactivity – Smoking – Genetics – Obesity – Diabetes – Infection and inflammation Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Screening and assessment of CVD – Screening should occur about every five years beginning at age 20 – Levels of the factors listed are used to target interventions and determine the aggressiveness of therapy Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Nutrition assessment – Key assessment components Food and nutrition history Nutrition knowledge Physical activity Anthropometric measurements Laboratory values Medical and social histories Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Nutrition interventions for CVD – Primary prevention Cardio-protective diet: emphasizes plant foods (e.g., vegetables, fruits, whole grains), appropriate fats, fish, poultry, legumes, nuts, and low-fat dairy Therapeutic life changes – More intensive intervention Behavioral counseling and follow-up by health care providers Recommended for individuals at high-risk Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Stanols/sterols – Essential component of plant cell membranes Resemble chemical structure of animal cholesterol When eaten, block particles responsible for cholesterol transport Viscous fiber – “Sticky” type of soluble fiber found in oats, barley, etc. Responsible for fiber-related physiological effects of decreased LDL Copyright © 2017 Cengage Learning. All Rights Reserved.  Cardiovascular Disease (cont’d.) Pharmacotherapy of CVD – Two drugs are used to lower blood cholesterol levels Ezetimibe inhibits intestinal absorption of cholesterol Statins work by blocking the enzyme (HMG-CoA) responsible for making cholesterol in the liver Copyright © 2017 Cengage Learning. All Rights Reserved.  Metabolic Syndrome Cluster of altered metabolic conditions that come together in a single individual – Place that person at high risk for coronary artery disease, stroke, and type two diabetes Abdominal obesity, elevated blood pressure, insulin resistance, and dyslipidemia Copyright © 2017 Cengage Learning. All Rights Reserved.  Metabolic Syndrome Copyright © 2017 Cengage Learning. All Rights Reserved.  Metabolic Syndrome (cont’d.) Prevalence of metabolic syndrome – Affects over a fifth of U.S. adults – Prevalence has declined slightly in 10 years, but metabolic conditions leading to diagnosis have changed substantially Copyright © 2017 Cengage Learning. All Rights Reserved.  Metabolic Syndrome (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Metabolic Syndrome (cont’d.) Etiology of metabolic syndrome – Thought to result from central adiposity and insulin resistance Effects of metabolic syndrome – Increases risk for several chronic conditions Atherosclerotic cardiovascular disease Type II diabetes Heart disease Stroke Copyright © 2017 Cengage Learning. All Rights Reserved.  Metabolic Syndrome (cont’d.) Screening and assessment – Waist circumference – Fasting lipid profile Nutrition interventions for metabolic syndrome – Reduce risk of atherosclerotic diseases and progression to diabetes – Intervention is directed to the problem identified Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus Chronic disease associated with abnormally high levels of blood glucose – Type I Minimal or no production of insulin by pancreas – Type II Defective production of insulin and insulin resistance – Prediabetes Blood glucose levels are marginally elevated and vascular changes occur Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Prevalence of diabetes – Over 28.9 million adults over 20 years have diabetes – Over a third of adults have prediabetes Correlates with overweight and obesity Most often people over age 40 Increasing in younger adults and children – Higher in racial and ethnic minorities Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Etiology of diabetes – Type I: progressive autoimmune disease – Type II: insulin resistance that develops over time Physiological effects of diabetes – Numerous: frequent urination, increased thirst, increased hunger, fatigue, weight loss, blurred vision, etc. Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Screening and assessment – Risk factors for diabetes and prediabetes 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 Woman with polycystic ovary disease Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Nutrition assessment – Diabetes management plan determinants Weight status Current eating pattern Knowledge about diabetes Physical activity Laboratory values Medical and social history Past education and experiences Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Interventions for diabetes – Management of diabetes: clinical goals Normalize blood glucose and glucose metabolism Prevent or slow the progression of diabetes complications Normalize lipid levels and blood pressure – Patient-centered care is provided by a collaborative, interdisciplinary team Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Medical nutrition therapy for diabetes – Diet flexibility and individualization Diet plan Calorie level Dietary intake Physical activity Medications Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Carbohydrate management – Carb counting: foods are classified in groups that have similar carbohydrate, protein, and fat profiles – Plate method: half nonstarchy vegetables, a quarter lean protein, and a quarter starch Not as accurate, but easier to learn Copyright © 2017 Cengage Learning. All Rights Reserved.  Diabetes Mellitus (cont’d.) Self-monitored blood glucose – Glucometer is used to record values Physical activity in diabetes management – Benefits: aiding weight loss and maintenance and improvement of insulin/ glucose profile, as well as reducing lipids and blood pressure Herbal remedies and other dietary supplements – Few supported; caution is necessary Copyright © 2017 Cengage Learning. All Rights Reserved.  Cancer A group of diseases in which genes malfunction – Resulting in unregulated cell growth and tumor formation Carcinogenesis – Process by which normal cells are transformed into cancer cells Copyright © 2017 Cengage Learning. All Rights Reserved.  Cancer (cont’d.) Prevalence of cancer – First leading cause of death for adults 45–65 – Third leading cause of death for adults 24–44 Etiology of cancer – Age associated but not age dependent – Caused by exogenous (environmental) and endogenous factors Copyright © 2017 Cengage Learning. All Rights Reserved.  Cancer (cont’d.) Screening and assessment – Modifiable risk factors and primary prevention Smoking, obesity, insulin resistance, excess alcohol consumption, and poor dietary habits – Primary prevention: early screening Nutrition assessment following diagnosis and during treatment – Anthropometrics, food and nutrition history, medical and social history Copyright © 2017 Cengage Learning. All Rights Reserved.  Cancer (cont’d.) Nutrition interventions for cancer – Prevention: healthy diet and physical activity – Treatment: medical nutrition therapy is a part of care during treatment with chemotherapy, radiation, and surgery and recovery – Periods of remission: healthy eating is encouraged – Nutrition care during advanced stages of the disease: food and fluid intake are adjusted Copyright © 2017 Cengage Learning. All Rights Reserved.  Cancer (cont’d.) Alternative medicine and cancer treatment – Some herbal products have potentially useful roles to ameliorate nausea and common symptoms Ginger capsules Ginger or chamomile tea Copyright © 2017 Cengage Learning. All Rights Reserved.  Thank you! Any questions? ([email protected]) 03 97692974 Copyright © 2017 Cengage Learning. All Rights Reserved.