Get documents about "Nutrition_for_the_Life_Cycle 2003ppp pot
Document Sample
Nutrition for the Life Cycle
Jodene Imeson R.D., R.N.
August 2010
Objectives
• Describe guidelines for nutrient and
energy needs during stages of the life
cycle including: infancy, childhood,
adolescence, adulthood and geriatric
periods.
• State nutrition related area’s of concern in
each lifecycle stage.
Objectives…
Describe the following nutrition related concern in each
life cycle stage:
– Infancy
• Breast vs. formula fed
• Introducing solid foods
• Food allergies and intolerance
– Childhood
• Establishing eating behaviors
• Childhood obesity
• Hyperactivity
– Adolescence
• Eating disorders
• Substance abuse
Objectives…
Describe the following nutrition related concern
in each life cycle stage:
– Adulthood
• Healthy habits
• Metabolic syndrome
– Geriatric
• Drug - nutrient interactions
• Pressure wounds
Infancy
Energy and Nutrient Needs
• Energy Intake
– Growth needs:
• Doubles wgt by 5 months (14-16 #, 6-7 kg)
• Triples wgt by 1 year (21 – 24#, 9.5-11 kg)
• Average wgt of 20-25 lbs by 1 year of age
• Kcals: 100/kg
– Support rapid growth rate during 1st 6 months, then
increased activity level in 2nd 6 months
Energy and Nutrient Needs
• Nutrient Sources
– CHO: 60% of daily energy intake to feed the brain
• 0 - 5 months - 60 gm/qd
• 5 -12 months - 95 gm/qd
– Fat: supports rapid growth
• 0 - 5 months - 31 gm/qd
• 5 -12 months - 30 gm/qd
– Protein: basic building block of the body
• 0 - 5 months - 1.52 gm/kg/qd (9.5 – 11 gm/qd)
• 5 -12 months - 1.50 gm/kg/qd (14 – 17 gm/qd)
Energy and Nutrient Needs
• Vitamins/Minerals
– Need greater amounts than an adult, based on body size
• Fat Soluble: A4.5x, E2.5x, D10x
• Water Soluble: C4.5x
• Minerals: Calcium2x, Iodine7x
• Water
– Younger the infant the higher the % of water wgt
– Infants do NOT need supplemental water
• 0 – 5 months: 116 cc/kg (1.5 – 1.75 c/qd)
• 5-12 months: 88 cc/kg (3.3 – 3 c/qd)
– Most water is in extracellular compartment – dehydration occurs
quickly (fever, vomiting, diarrhea)
• Rehydrate with electrolyte solution designed for infants
Breast is Best
• American Academy of Pediatrics and American
Dietetic Association advocate breast feeding
over formula feeding
– High bioavailability of nutrients
– Best nutrient composition
– Immuno-protective
– Promotes physiologic and cognitive development
– Non allergenic
– Sterile
– Cost effective
– Environmentally friendly
Breast Milk – Nature’s Perfect Food
• Energy Nutrients
– CHO: disaccharide lactose
• Easily digested, enhances Ca2+ absorption
– Protein: alpha-lactalbumin
• Efficiently digested, absorbed
• Lower protein content, less damage to kidneys
– Fat: Essential fatty acids (EFA)
• Linoleic, Linolenic,
– Non EFA’s: Arachadonic, Docosahexaenoic (DHA)
» Being added to formula’s
Breast Milk – Nature’s Perfect Food
• Vitamins/Minerals
– Calcium content perfect for bone growth, well
absorbed
– Iron in small amounts but highly available
– Supplements Needed
• Vitamin K at birth – to prevent hemorrhaging
– Sterile intestine. Takes 6 months for bacteria producing
Vitamin K to grow
• Vitamin D from birth to 12 mos:
– Breast milk is low in Vit D content
– Need 500 cc qd of Vit D fortified formula or a supplement
Breast Milk – Nature’s Perfect Food
• Vitamins/Minerals
– Fluoride after 6 months
• low content in breast milk and infants reserves are
used up. If fluorinated water is used to prepare
formula’s and food, no supplement is needed
– Iron after 6 months
• RDA jumps from 0.27 mg/qd to 11 mg/qd at 6 mos
Breast Milk – Nature’s Perfect Food
• Colostrum: antibodies, white blood cells
• Protection from infections to which mom has developed
immunity
• Bifidus: promotes growth of Lactobacillus bifidus
– Keeps harmful bacteria in check
• Lactoferrin: iron binding protein
– Helps prevent growth of harmful intestinal bacteria
• Lactadherin: protein that fights diarrhea-causing viruses
• Growth Factor
– Aides in development of infants digestive tract
• Lipase: helps fight infection
Formula Feeding
• Formula standards set by the AAP reflect
human milk from the 1st or 2nd month of
lactation
• FDA mandates safety, nutritional quality
• Select the appropriate formula
– Ask your pediatrician
• Enfamil, Similac, Carnation, Parent’s Choice
Formula Feeding
• Formula baselines
– Cow’s milk: majority of available formula’s
• Whey, caseinate protein
• Iron fortified
– Soy
• Soy protein
• Additives: cornstarch, sucrose
– Elemental
Formula Feeding
– Risks of formula feeding
• No protective antibodies
• Formula’s become contaminated leading to
infection
– Sterilize bottles
– Sterile water
– Refrigeration
• Expiration dates
• Cost
Advancing the Diet
Developmental Skills
Feeding Skill Food to Add
• 0 – 4 mos • Breast Milk, infant formula
– Swallows using back of tongue
– Strong extrusion reflex to push
food out
• 4 – 6 mos • Iron fortified cereal
– Extrusion reflex decreases
– Begins chewing action • Puree vegetable and fruit
– Brings hand to mouth
– Grasps with palm of hand
• 6 – 8 mos
– Able to feed finger food • Textured vegetable, fruit
– Begins to drink from cup • Diluted fruit juice in cup
– Develops finger to thumb grasp
Developmental Skills
Feeding Skill Food to Add
• 8 – 10 mos • Table cereals, bread
– Holds own bottle • Yogurt
– Grabs spoon, fork • Soft cooked table
vegetables and fruit
• Begin finely cut meat, fish,
casseroles, cheese, eggs
• 10 -12 mos
• Progress to food pyramid
– Masters spoon with some
suggested servings
spillage
Advancing the Diet
• Cow’s milk
– Nutrient content
• High protein, calcium
• Low iron, Vitamin C
– Wait until at least 1 yr of age before
introducing
• May cause GI bleed and loss of iron
• Higher protein content stresses infants kidneys
– Whole milk (5% fat content) for first 2 yrs
– Transition to 2% fat content between 2 - 5 yrs.
Introducing Solid Food
• 4 – 6 months of age
– Physically, metabolically able
– Introduce foods with nutrients no longer available in
breast milk, or reserve stores are depleted
• Introduce one food at a time
– Use small portions (2 - 3 tbs)
– Wait 4 – 5 days before introducing another new food
– Start with iron fortified cereals, then pureed
vegetables and fruits
– Avoid potential allergen’s
• Wheat, cow’s milk
Introducing Solid Food
• Nutrient considerations
– Do NOT restrict Fat content in a child less
than 2 yrs of age
• Toddler food labels can’t provide fat levels -
prevents attempts to restrict fat intake
– Iron needs from food increase:
• Infant stores are depleted
• Breast milk can’t supply adequate amounts
• Iron fortified cereals - poor bioavailability
add vitamin C source to aid Fe absorption
Introducing Solid Food
Nutrient considerations….
– Limit fruit juice to 4-6 oz a day thru age 6 yrs
• Must be diluted for infants 6 – 8 months
• Serve from a cup, not in a bottle
– Omit baby desserts and sweets
• Sugar is an innate taste
• Provide only empty calories
• Promote obesity
– Avoid Honey, Corn syrup
• botulism
Introducing Solid Food
• Choking Hazards
– Hot dogs - Peanut Butter
– Popcorn - Nuts
– Grapes - Cherries
– Hard or gel candies - Gum
– Marshmallows
– Raw celery, carrots
Mealtime with
Toddlers
Provide
nutritious
foods and
beverages in
a safe, loving
and secure
environment
Mealtime with Toddlers
• Don’t allow unacceptable behavior. Be firm,
not punitive
– Throwing food, standing to eat
• Use finger foods to allow exploring
• Don’t force foods
– Need repeated experience to accept them
• Allow choices from variety of nutritious foods
• Limit sweets
• Don’t use food as a reward
• Keep meal time pleasant
Food Allergies
• Food allergy:
– 3 - 5% of children develop true allergy
– occurs when large molecule proteins in the blood
stimulate an immune response with creation of
antibodies
• Will be confirmed by antibody (Ab) testing
– Symptoms may or may not occur
– Immediate vs up to 24 hrs delayed reaction
• Food intolerance:
Food Allergies
• Allergic reaction
– Anaphylactic shock
• Hives, rash, swelling
• Difficulty breathing, asthma attack
• Swelling of mouth, tongue, throat
• Tingling sensation in mouth
• Vomiting, GI cramps, diarrhea
• Hypotension
• Loss of consciousness
• Death
Food Allergies
• Most Common Food Allergens
– Peanuts*: #1 risk for life threatening reactions
– Tree nuts
– Milk*
– Eggs*
– Soy*
– Wheat
– Shellfish, fish
* cause most reactions in children
• Food labels must state if contain allergy
producing food
Food Intolerance
• Symptoms occur but no antibodies are formed
– Adverse Reactions
• Hives
• Wheezing, cough, bronchial irritation
• Rapid heart rate
• Stomachache, diarrhea, cramping
• Headache
– Other agents causing adverse reactions
• Food chemicals: MSG, red/yellow dye
• Pesticides
• Lactose
• Sulfur
• Psychological aversion
Childhood
Energy and Nutrient Needs
• Energy Needs
– Growth
• Gains 2 - 3 inches in height per year
• Gains 5 - 6 pounds per year
• Increase in muscle and bone mass and density
– Total calories/Kg needed declines with age
• “Growth Spurt” intermingled with periods of little to
no growth
• Meal patterns will coincide with growth patterns
Energy and Nutrient Needs
Age Kcal needs
• 1 – 3 years • 85 kcals/kg 1000 kcal qd
– Females 82 kcal/kg
– Males 87 kcal/kg
• 4 – 8 years • 85 kcals/kg 1650-1750
kcals/kg
– Females 82 kcal/kg
– Males 87 kcal/kg
• 9 – 13 years • 60 kcals/kg 2000-2250
kcals/kg
– Females 56 kcal/kg
– Males 63 kcal/kg
Energy and Nutrient Needs
• Nutrient Sources
– CHO: brains need for CHO is constant with that
of an adults brain after 1 year of age
• 130 gms CHO qd
– Fat: no RDA established
• 1 – 3 years: 30 – 40% of total kcals
• 4 – 13 years: 25 – 35% of total kcals
– Protein: requirement decreases with age
• 0 - 5 months: 1.52 gm/kg/qd
• 5 -12 months: 1.50 gm/kg/qd
Energy and Nutrient Needs
• Vitamins and Minerals
– Well balanced diet doesn’t require supplementation
except for Vitamin D and fluoride
• Vitamin D may be adequate with sunlight exposure
• Fluorinated water supply meets the need
– Iron deficiency
• #1 nutrient deficiency in childhood
– Offer iron fortified infant formula’s and cereals
– Critical time for brain growth and development
» used to make neurotransmitters that regulate
attention span and learning ability
• 7-10 mg Fe qd
Developmental Skills
Age Food Skill
• 1 – 2 years • Uses short handled spoon.
• Feeds self
• Lifts and drinks from cup
• 3 years • Spears food with fork
• Feeds independently
• Helps pour, mix, spread food
• Uses all utensils
• 4 years
• Helps mash, roll, peel foods
• 5 years • Helps measure, cut soft foods
Establishing Eating Behaviors
• Children have increased influence on
family food decisions. Parents have
responsibility to teach good nutrition and
consumer skills
• Television commercials
• Family eating out
• Make choices with school lunches
Establishing Eating Behaviors:
Children’s Preferences
• Raw vegs to cooked • Child sized table
• Warm foods to hot • Small portions
• Mild flavors • Geometric shapes
• Smooth textures • Silly names
• Familiar foods • Eating with friends
Establishing Eating Behaviors
– Allow children to help plan meals and prepare
foods
– Offer new foods one at a time, in small portions,
at the beginning of the meal when the child is
hungriest
– Let the child decide for themselves what food
they want to select from the healthy foods
presented to them. Do NOT force unfamiliar
foods
– Power struggles over food sets up resistance and
closes a child’s mind to eating
Establishing Eating Behaviors
– Let the child choose what, how much and
when to eat. They need to learn to listen to
their internal satiety cues
– Provide nutritious snacks and let the child
choose for themselves what to eat
• Snacks may consist of mealtime foods eaten at a
time the child is ready to eat them
– Limit but don’t restrict access to high fat/sugar
foods and favorite foods
• If food is restricted the child will want it even more
Establishing Eating Behaviors
• Play first, then eat
– Child is more relaxed and hungry
– Will be racing thru meal to get down to play
• Brush and floss
– Establish good dental care early in life
• Monitor for choking
– Children typically have silent choking
Childhood Obesity
Childhood Obesity
• 1 of 3 US children are considered
overweight or obese
– Overweight
• Greater than 95th percentile
• Number of overweight children has more than
doubled in 20 years
• 15% of US children are at risk of becoming
overweight
• Greater than 85th percentile
Childhood Obesity
• Body Mass Index (BMI) is used as a
screening tool to plot percentile on
standardized growth charts
– BMI Formula lbs x 703
inches2
• Does not account for muscle vs fat
content, larger than average body frame
sizes, varying growth rates
Childhood Obesity
• Risk Factors
– Diet: loading up on fast foods, high fat and
sugar snacks
– Lack of exercise: television, video games
replace outdoor activities and burning of kcals
– Family History:
• Parental obesity doubles the chance a child will
become an obese adult
• Non-obese children with non-obese parents have
<10% chance of becoming obese adults
Childhood Obesity
• Risk Factors
– Psychological factors: coping mechanism for
stress, emotions, boredom
– Family Habits: types of foods purchased, how
meals/snacks are served in the home
– Socioeconomic: low income children are at
greater risk of obesity
– Medical: genetic syndromes, endocrine
disease, medications
Complications of Childhood Obesity
• Physical Complications
– Type II diabetes, insulin resistance
– High cholesterol, abnormal lipid ratio’s
– High blood pressure
– Metabolic Syndrome
– Asthma, shortness of breath
– Sleep disorders
– Early puberty and menstruation
Complications of Childhood Obesity
• Psycho-Social factors:
– Low self esteem
– Depression
– Hopelessness
– Flat affect
– Socially withdrawn
– Behavior and learning problems
Prevention of Childhood Obesity
Prevention of Childhood Obesity
• Healthy Eating
– Limit sweetened beverages
• Regular soda, fruit juice
– Provide healthy snacks
• Fruits, raw vegetables, plain crackers and cookies
– Do NOT limit all sweets and favorite snacks
• Children will rebel and find ways to get these items
– Limit the meals eaten outside the home
• Avoid Fast Food. Use sit down restaurants with limited
portions, heart healthy entrée’s
– Eat together as a family
• turn off the tv, video, computer, phones
Prevention of Childhood Obesity
• Increase Physical Activity
– Limit computers, video games, tv watching to
2 hours a day
• Don’t snack while involved in sedentary activities
• Keep electronic “toys” out of the bedroom
– Emphasize physical activities, not exercise
• Active free play games (hide-n-seek, bike riding,
skateboarding, neighborhood park, family walks)
• Bowling, swimming, organized sports teams
Prevention of Childhood Obesity
• Psycho-Social Support
– Don’t focus on your child’s weight concerns
– Praise your child’s efforts, no matter how small
the change
– Focus on positive, incremental goals
– Don’t reward or punish with food
– Listen to your child’s feelings and needs
– Be patient
– Set a good example of diet and exercise yourself
Nutrition in Behavioral Concerns
• Sugar Lows & Highs
– Need CHO intake every 4 hours to maintain
steady stream of glucose to power the brain and
nervous system
• School breakfast program
• Nutritious mid-morning snack
• Iron deficiency
– Affects neurotransmitters regulating attention
span, learning ability (serotonin)
• Brain is sensitive to iron deficiency before blood anemia
clinically appears
Nutrition in Behavioral Concerns
• Types of ADHD (Attention Deficit Hyperactivity Disorder)
– Combined: Inattentive/Hyperactive/Impulsive
– Hyperactive/Impulsive
– Inattentive
Nutrition in Behavioral Concerns
• Symptoms of ADHD
– constant motion
– squirm, fidget
– don’t listen
– talk excessively
– interrupt
– can’t play quietly
– easily distracted
– don’t finish tasks
Nutrition in Behavioral Concerns
• Hyperactivity
– No studies consistently show evidence of
dietary impact on hyperactive behavior
– Diets too restrictive may lack vitamins and
nutrients required for adequate growth
– Recommend high protein, moderate complex
CHO, low simple CHO
Nutrition in Behavioral Concerns
• Possible Elimination Items
• Artificial Food colorings
– FD&C Red #40 (allura red)
– FD&C Red #3 (erythrosine)
– FD&C Yellow #6 (sunset yellow)
– FD&C Yellow #5 (tartrazine): must be on food label
» Beverages, candy, ice cream, custards
• Food Additives
– Aspartame: sweetener
– Monosodium Glutamate (MSG): flavor enhancer
– Nitrites
» Used to preserve color, enhance flavor, protect against
bacterial growth
Nutrition in Behavioral Concerns
• Possible Useful Supplements
– General Multivitamin/Mineral
– Omega 3 Fish Oil: improved mental skills in 8-
12 yr olds
• Salmon, albacore tuna, trout, mackerel
– Zinc: reduction in hyperactivity, impulsivity
• Oysters, red meat, poultry, dairy, nuts, legumes
Nutrition in Behavioral Concerns
• Children need regular patterns of sleep,
meal times, activity/play times and
consistency in care
• Misbehavior may reflect inconsistent care
– Provide loving, supportive environment
Adolescence
Energy and Nutrient Needs
• Energy Needs
– Greater nutrient needs than any other time in life
except pregnancy/lactation
– Growth Spurt
• Females: age 10-11 at start of puberty
– Height: 6 inches
– Weight: 35 pounds
» Fat gains
• Males: age 12-13 at start of puberty
– Height: 8 inches
– Weight: 45 pounds
» Muscle and bone gains
Energy and Nutrient Needs
– Kcal – Fat
• Females: 44 kcals/kg • 25 – 35% of total
• Males: 51 kcals/kg kcal needs
– CHO – Fluid
• 130 g/qd • Females: 2.3 liters
• Males:
– Protein 3.3 liters
• 0.85 g/kg
Energy and Nutrient Needs
• Vitamins/Minerals
– Vitamin D: needed for intense bone growth
• Absorption enhanced by hormone production and
sunlight exposure
• No additional supplementation needed
– Calcium: needed for intense bone growth
• Need 4 servings from dairy group a day
• Most teenagers are well below the Adequate Intake (AI)
– Increased risk for osteoporosis in later years
Energy and Nutrient Needs
• Vitamins/Minerals
– Iron
• Needs dependent on growth spurt and beginning
of puberty
• Females begin menstruation
– Need 8-16 mgs/qd
• Males develop increased lean body mass
– Need 8-14 mgs/qd
Food Choices and Health Risks
• Snacking
– Comprises 1/4th of teenagers intake
• High in sugar, fat, salt
• Low in fiber, calcium, iron, Vit’s A/C/folate
• Beverages
– Soft Drinks
• 3x increase in use of soft drinks
– Higher sugar intake
– Lowers calcium intake overall
– Higher acid intake corrodes tooth enamel
• Caffeine
• Eating Out
– 1/3rd of all meals are eaten outside the home
– Fast Food
• No fruit, vegetables, milk
Food Choices and Health Risks
• Nutrition Needs
– Education
• In the home, at school
– Nutritious lunch choices at school
– Limit vending machine choices in school
– Keep healthy snack foods available at home
– Family meal times together
Nutritional Impact of Substance
Abuse
• General Concerns
– Money used on drugs rather than food
– Lifestyle of drug use does not promote
healthy eating habits
– Drugs impact appetite
• Taste alterations
• Depressant
• Don’t eat during “highs”
• “Munchies”
Nutritional Impact of Substance
Abuse
• Marijuana
– Cannabinoids regulate appetite, pain, memory
• “Munchies” – intense craving for sugary items
• Ecstasy
– Impacts serotonin: appetite, sleep, body temperature,
mood, memory
• Weight loss
• Cocaine
– Elicits stress response
• Crave cocaine rather than food
• Weight loss
• Eating disorders
• Dehydration, electrolyte imbalance
– Stroke, seizure, heart attack, death
• Tobacco
Nutritional Impact of – Decreases feelings of hunger
Substance Abuse – Maintains lower body weight
– Lower intakes of Vit A, beta-
carotene
• Increased risk of cancers (lung)
– Depletes body of Vit C
• Need 35 mg/qd more intake (100
-110 mg/qd)
• Smokeless tobacco
– Higher risk of mouth and
throat cancers
– Stained teeth, bad breathe
– Alteration in taste and smell
– Destruction of tooth surfaces,
gums, jawbones
Nutritional Impact of Substance
Abuse
• Alcohol
– 7 kcals/gm – no other nutrients provided
– Interferes with metabolism
• Protein energy malnutrition (PEM)
• Diuretic – can result in increased thirst
• B vitamin deficiencies: B6, thiamine, folate
– Impacts digestive system function in general
– Increased homocysteine – heart disease
– Impaired memory, poor muscle coordination, nerve damage
– anemia
– Depressant: slows/inhibits activity of the brain
– Narcotic: used as an anesthetic to deaden pain
Eating Disorders
• Anorexia nervosa:
– Characterized by (DSM-IV)
• low body weight (< 85 percent of expected weight)
• intense fear of weight gain
• inaccurate perception of body weight or shape
• Amenorrhea for at least 3 menstrual cycles
– mean age of onset - 17 years
– 1% of American teenage girls
Eating Disorders
• Bulemia
– Characterized by (DSM-IV)
• binge eating (can’t stop or control what is being
eaten)
• compensatory activities
– Purging activities: Vomiting, diuretics, laxative abuse,
enema
– Non-purging activities: Fasting, extreme exercise
• binge eating and compensatory strategies occur at
least 2x/wk for 3 months
Eating Disorders
• Multifactorial etiology
– Individual
– Family
– Biological
– Psychological
– Cultural
– Development of body image
• Comorbid disorders are common
– Affective disorder
– Anxiety disorder
– Personality disorder
– Substance abuse
Eating Disorders
• Failure to accomplish the tasks of
adolescence:
– Adapting to their adult body image
• Unrealistic perceptions of body size
• Failure to normalize eating and exercise patterns
– Development of autonomy
• Unrealistic expectations for themselves
– Development of self esteem
• Preoccupation with weight and food, reflecting
dependence on social opinion and judgment
Eating Disorders
• Intervention Strategies
– Psychotherapy
– Medical monitoring
– Nutrition
– Health education
– Dental care
Eating Disorders
• Strategies to combat eating disorders
– Eat frequently, use healthy snacks
• Don’t skip meals, or “diet”
• Don’t allow hunger to dictate food choices
– Eat at the table using utensils to control eating
– Plan meals and snacks. Keep a food diary
– Utilize the Food Guide Pyramid for amounts/portions
of foods to eat daily
– Consume adequate fluid
– Establish a reasonable weight goal, allow reasonable
time to reach that goal
• Gain/Loss of 10% of body wgt in 6 months
• Exercise 30 minutes a day
Adulthood
Healthy Habits
• As much as 75% of a persons life
expectancy is dependent on individual
health related behaviors
– Regular, adequate sleep
– Regular, well balanced meals
– Regular physical activity
– Not smoking
– No or moderate alcohol use
– Maintain healthy body weight
Healthy Habits
• Benefits of exercise
– Flexibility
– Endurance
– Muscle strength
– Balance
– Improved mobility
– Reduced chance of falls
– Lower BP, lipid levels
– Weight control
Metabolic Syndrome
• Syndrome X or insulin resistant syndrome
– Body is resistant to insulin leading to
hyperinsulinism, which in turn leads to…
• Risk factors for Cardiovascular Disease
– Hypertension
– Hyperlipidemia
– Diabetes
Metabolic Syndrome
• Defined by 3 or more of the following criteria
(Adult Treatment Panel III, National Cholesterol Education Program)
– Waist circumference (apple shape)
• >40 inches in men (>102 cm)
• >35 inches in women (> 88 cm)
– HDL Cholesterol
• <40 in men
• <50 in women
– Triglycerides >150 mg/dl (1.7 mmol/L)
– Glucose >110 mg/dl (6.1 mmol/L)
– Blood pressure > 130/85
Metabolic Syndrome
• Additional co-morbidities
– Excessive blood clotting
– Fatty liver
– Low grade inflammation
• Uric acid increases
• High C Reactive Protein (CRP)
Metabolic Syndrome
• Underlying risk
factors
– Obesity
– Physical inactivity
– Diet high in fats
• Major risk factors
– Cigarette smoking
– Hypertension
– Family history of
coronary heart disease
Metabolic Syndrome
• LIFESTYLE CHANGE
– Weight reduction to <25 BMI
• Weight loss of 7 - 10% in the first year
• Low fat, low cholesterol diet
• Low simple carbohydrate diet
• More fresh fruits, vegetables, whole grains
– Reduce sodium intake
– Increase physical activity
– Stop smoking
The Golden Years
Energy and Nutrient Needs
• Nutrient Needs
– Basal metabolic rate decreases 1-2% per
decade
• Calories must come from nutrient dense foods
– Lean body mass decreases
• Need High biological value (HBV) protein for
immune system and to prevent muscle wasting
– Total body water decreases
• Leads to rapid dehydration
– UTI’s, pneumonia, confusion, pressure ulcers,
Energy and Nutrient Needs
– Kcal – Fat
• Females: 25 kcals/kg • 20 – 35% of total
• Males: 30 kcals/kg kcal needs
– CHO – Fluid
• 130 g/qd • 30 cc/kg
– Protein • Females: 2.1 liters
• Males: 2.6 liters
• 0.8 g/kg
Energy and Nutrient Needs
• Vitamins/Minerals
– Vitamin D: 10 – 15 micrograms/qd
• Limited exposure to sunlight
• Reduced ability of aging skin to convert Vit D
• Inability or kidneys to convert Vit D to active form
– Calcium: 1200 mg/qd
• Dairy products
• Ca2+ fortified juices
• Calcium supplements
– Iron: 8-10 mg/qd
• Chronic blood loss from disease, medicine
• Poor absorption from altered GI secretions
Drug-Nutrient Interactions
Drugs Alter Nutrient
Absorption Foods Alter Drug Absorption
• Alter acidity of GI tract • Alter acidity of GI tract
• Alter digestive juices • Alter digestive juices
• Bind to nutrients • Bind to drugs
• Alter GI motility • Alter rate of drug
– Transport time thru GI system absorption
• Inactivate enzyme system • Compete for absorption
• Damage mucosal cells sites in the GI tract
Drug-Nutrient Interactions
Drugs Alter Nutrient
Drugs Alter Food intake Excretion
• Impact appetite • Alter renal reabsorption
• Interfere with taste, smell – K+, Na+. Ca+
• Induce nausea/vomiting • Displace nutrients from
• Change oral environment protein carriers
• Inflame the mouth
• Irritate GI tract
Drug-Nutrient Interactions
Not Absorbed Well w/Food Absorbed Better w/Food
• Acetaminophen • HCTZ
• Aspirin • Aldactone
• Antibiotics” • Propanolol, Metoprolol
– “cillins”, “cycline” • Carbamazepine/Tegretol
Erythromycin
• Diazepam/Valium
• Atenolol, Captopril
• Lithium
• Levodopa/Sinemet
• Phenytoin/Dilantin
• Rifampin, Isoniazid
Drug-Nutrient Interactions
• Do not take with Caffeine
– Antihypertensives
– Antipsychotics/depressants/anxiety
– Anticonvulsants
– Antiulcer
– Oral hypoglycemics, insulin
– Diuretics
– Sedatives/Stimulants
Drug-Nutrient Interactions:
Caffeine Content
• Coffee, brewed (5 oz) 130 • Excedrin (1 tab) 65
Coffee, instant (5 oz) 75
• Midol (1 tab ) 30
Tea, Brewed (5 oz) 40
Tea, Iced (12 oz) 70 • No Doz, Vivarin 100
• Cola’s (12 oz) 40 • Dexatrim (1 tab) 100
• Mt Dew (12 oz) 52
• Milk chocolate (1 oz) 6
• Dark chocolate (1 oz) 20
Pressure Wounds
– Functions of Skin
• Largest “organ” of the body
• 1st line of defense
• Touch, pain, pressure, temperature sensation
• Assists in temperature regulation
• Excretion of metabolic waste
• Identification based on individual characteristics
• Communication of emotions
Pressure Wounds
Skin Layers Staging of Wounds
Epidermis: outer layer • Stage I – intact skin
(Non-blanchable redness)
• Thin but tough, no
blood vessels
Dermis: inner layer • Stage II – Partial thickness
• Thick connective • Stage III – Full thickness
tissue/collagen
• Supplies blood, oxygen,
nerves
Subcutaneous: adipose tissue • Stage III
Fascia: muscle, bone, tendon • Stage IV
Pressure Wounds
• Interruptions in skin integrity
– Abrasions, lesions
– Burns
– Diabetic ulcers
– Pressure ulcers
– Venous stasis ulcers
– Others
• Sickle cell anemia ulcers
• Arterial insufficiency ulcers
Pressure Wounds
• Risk factors for Pressure Ulcers
– Disease Process/State of Health
– Nutrition/Hydration
– Mobility/Activity
– Incontinence
– Level of consciousness
– Medications
Pressure • Common Sites of
Wounds Pressure Wounds
Lumbar spine, hips
– Hip area (trochanter, ischial
tuberosity)
– Heels (Malleolus, calcaneus)
– Toes (metatarsals)
– Spinal column (thoracic,
lumbar, sacrum, coccyx)
– Elbow (olecranon)
– Scapula
– Back of head (occipital area)
Pressure Wounds
Stage Calories Protein Fluid
I 30-35 kcal/kg 1.2 gm/kg 30-35 cc/kg
II 30-35 kcal/kg 1.2 gm/kg 30-35 cc/kg
III 35 kcal/kg 1.3-1.5 gm/kg 30-35 cc/kg
IV 35 kcal/kg 1.5-2.0 gm/kg 30-35 cc/kg
Pressure Wounds
• Supplementation
– Multivitamin/minerals
– Vitamin C (controversial):500 mg qd x 14 days
– Zinc (controversial): 220 mg x 14 days
– Arginine: 17 - 24.8 gms/qd
– Glutamine: 0.57 gm/kg
Nutrition for the Life Cycle
Resources
• www.kidshealth.org Nemours Foundation
• www.kidfood.org American Dietetic Assoc.
• www.shapedown.com Weight loss tips for children
• www.chadd.org Children & Adults w/hyperactivity, ADD
• http://fnic.nal.usda.gov/nal Food and Nutrition Information Center
• http://www.nlm.nih.gov/medlineplus/ National Library of Medicine, National
Institute of Health
• www.npuap.org National Pressure Ulcer Advisory Panel
• http://www.nal.usda.gov/fnic/foodcomp/Data USDA Nutrient Database
Throw Your Weight Around:
Diet & Exercise Plan
• Climbing the ladder of success 750
• Making mountains out of molehills 500
• Running around in circles 350
• Throwing your weight around 50-300
– (depending on your wgt)
• Wading through your work 300
• Putting the cart before the horse 300
• Pushing your luck 250
• Eating Crow 225
• Jumping on the bandwagon 200
Throw Your Weight Around:
Diet & Exercise Plan
• Climbing the Walls 150
• Jumping to conclusions 100
• Dragging your heels 100
• Pulling your hair out 100
• Pulling out all the stops 75
• Bending over backwards 75
• Beating around the bush 75
• Stirring up the pot 50
• Tooting your own horn 50
Related docs
Other docs by I1t0n4k3
