NHM 201 NHM 201
Popular in Nutrition in the Life Cycle
Popular in Nutrition and Food Sciences
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Date Created: 02/10/15
Chapter 10 AGE PERIODS Toddlers l 3 years Increases in gross and ne motor skills Greater independence language skills Preschoolers 35 years not attending kindergarten Increases in autonomy and language skills More social experiences learning to control behaviorNormal Growth Patterns Toddlers Gain 8 ounces 23 kg per month 04 inches 1 cm of height per month Preschoolers Gain 44 2 kg pounds per year 275 in 7 cm per year Applying Growth Charts Use Birth 36 months measuring recumbent length Use 2to20 years charts for gt2 years of age child who stands Applying Growth Charts Children gt2 years of age BMIfor age 85th 94th percentile overweight BMIfor age gt 95th percentile obese Adiposity or BMI Rebound BMI increases in infancy decreases in toddlers preschoolers and increases in adults Early adiposity rebound increases risk for obesity in adulthood Physical Activity Goals Dietary Guidelines At least 60 minutes PA on most ideally all days of the week Toddler Development Neurodevelopment Stairs Running Tricycles Unintentional Injuries are leading cause of death among young children Cognitive More interactive Social development Increased language with 3word sentences by age 3 years More determined to express their own will Development of Feeding Skills of Toddlers Weaning complete at 1214 months Chewing different textures 1218 months Picking up small objects 12 months Well developed chewing 1824 months Spoon feeding ability increases 1824 months can rotary chew clean lips with tongueToddler Feeding Behaviors Patience and Persistence Need for rituals Food jags Express strong preferences Imitate eating behavior of others Appetite and Food Intake in Toddlers Slower growth decreased appetite and interest in food Appropriate portion sizes 1 tbsp food per year of age Snacks ensure nutritional adequacy Preschool age children Physical Development hop jump on one foot climb throw Cognitive Development internal limits for behavior more organized group play magical thinking unable to accept another s point of view more language skillsPreschool age children Feeding Skills Uses a fork spoon cup well less messy Feeding Behaviors Growth spurts affect intake and appetite Prime time for teaching good eating habits How do children eat Prefer sweet and slightly salty tastes Prefer high energydense foods Adjust caloric intake based on caloric need In uenced by external cues Can already feel guilt about eating forbidden foods See Table 102 amp 103 for practical tips At 2 years Tear lettuce or greens Rinse vegetables or fruits and Snap green beans At 3 years Mash potatoes Squeeze citrus fruits and Stir pancake batter At 4 years Peel eggs and some fruits such as oranges and bananas Crack eggs and Help make sandwiches and tossed salads At 5 years Measure liquids Cut soft fruits with a dull knife and Use an egg beater Obesity prevention begins with toddlers The formula for Estimated Energy Requirements EER for children ages 13 36 months is 89 X weight of child kg 100 20 kcal for energy deposition For example a healthy 24month old girl who weighs 12 kg would have an EER of 89 X12 kg 100 20 988 kilocalories Energy and Nutrient Needs Protein Energy DRI p283 Ages 13 11gkgl3 gday Ages 48 95 gkg l9 gday Vitamins and Minerals 13 years Iron 7 mgday Zinc 3 mgday Calcium 500 mgday 48 years Iron 10 mgday Zinc 5 mgday Calcium 800 mgday Note watch excessive milk intake gt24 ounces milkday Iron Deficiency Anemia Causes long term delays in cognitive development and behavioral disturbances Highest risk at 918 months 12 years HGB ltllOgdL HCT lt329 25 years HGB ltlllgdL HCT lt330 More prevalent in lower income children Dental Caries Affects l in 5 children ages 24 Baby Bottle Tooth Decay primarily upper front teeth Increases risk of caries in permanent teeth Fluoride is important but an excess causes uorosis Battling Constipation in Young Children Fiber needs 13 yrs 19g total berday 48 yrs 25g total berday Chapter 11 and 13 Interrelated nutrition and feeding problems occur in many individuals with developmental disabilities Individuals with delays and disabilities are a diverse group Definitions Developmental Delay Development below accepted norms may be overcome remain mild Developmental Disability severechronic disability attributed to physicalmental impairment manifested before age 22 likely to continue inde nitely and has functional limitations Special health care needs General term for those at risk from a variety of factors Etiologies Hereditary Metabolic disorders Birth defects Premature births Exposure to harmful agents during pregnancy Complications in delivery trauma infection Postnatal accidents abuse Demographics Changes in the delayeddisabled population Prenatal drug and alcohol abuse Child abuse Prognosis for ELBW babies has improved More older individuals in this population as survival rates improve More people dependent on medical technology Services and Supports Legislation President Obama in Feb signed into law a bill that Will reauthorize and expand SCHIP to an additional four million children SCHIP was set to expire on March 31 Without congressional action Under the bill children in families with incomes of up to three times the federal poverty level Will qualify for the program Community based living rather than institutions Mandated free public education in least restrictive setting Child nutrition programs funded by USDA must provide for special needs DESCRIPTION OF DISORDERS Rett syndrome occurs only in females 11000015000 severe mental and physical impairment seizures common Cerebral palsy occurs in 2 1000 non progressive brain abnormalities result in disordered motor control and posture Disorders continued Down Syndrome Trisomy 21 occurs 1700 live births extra or abnormal chromosome 21 obesity becomes common in later life Prader Willi Syndrome occurs in 11000025000 live births abnormality in chromosome 15 Disorders continued Myelomeningocele inc spina bifida 121000 live births de cit in development toward end of rst prenatal month spinal cord protrudes in sac some place along the spine Sickle Cell Anemia 1 in 12 black AAs carry sickle cell trait 1375 will have the disease Infections anemia organ damage pain Maple Syrup Urine Disease Body cannot use the BCAAs leucine isoleucine and valine Severely restricted protein diet special formula for infants Fragile X Syndrome Boys 12000 girls 14000 Hereditary causes wide range of mental impairment associated with physical and behavioral 1ssues NUTRITIONAL NEEDS CONCERNS AND RISK FACTORS Altered nutritional needs due to Changes in physical size growth and energy needs Decreased linear growth Low weight for stature High weight for stature Altered energy needs Chronic Constipation Occurs in many disorders Related factors Decreased physical activity Inadequate uid and fiber intake Effects of medications Altered muscle tone Inability to establish bowel habits Altered Feeding Characteristics Physical characteristics and health of mouth area Neuromotor factors Behaviors Tube feeding Increased demands on time energy and nancial and emotional resources Inadequate information and support Nutrition Screening Assessment Intervention and Monitoring Degree of Assessment may include Health Social and Developmental Histories Clinical and Medical Assessment Anthropometric Assessment Biochemical Assessment Dietary Assessment Feeding Assessment Intervention should hopefully be person and family centered culturally competent communitybased coordinated interdisciplinary AND include the right of the patientclient to make choices Who is on the team The nutrition care plan may include medical dental treatment behavioral intervention feeding techniques including positioning equipment schedules texture temperature variety quantities of foods formulas supplements training to implement recommendations resources for assistance PKU An inherited error in phenylalanine metabolism most commonly caused by a de ciency of phenylalanine hydroxylase which converts the essential amino acid phenylalanine to the nonessential amino acid tyrosine Also called hyperphenylalaninemia 3 Cystic Fibrosis Condition in which a genetically changed chromosome 7 interferes with all the exocrine functions in the body but particularly pulmonary complications causing chronic illness Failure to thrive FTT is a condition in which an energy de cit is suspected FTT has a slightly different basis in toddlers and preschoolers who may have grown adequately during the rst year Their decrease in growth rate occurs at the age when appetite typically decreases and control issues at mealtime are expected making identifying the cause of FTT more dif cult Generally FTT is suspected when a child s growth declines more than two growth percentiles placing him near or below the lowest percentile in weightfor age weightfor length andor BMI FTT may result from a complex interplay of medical and environmental factors such as the following ODigestive problems such as gastrointestinal re ux or celiac disease oAsthma or breathing problems ONeurological conditions such as seizures OPediatric AIDS Chapter 12 Middle Childhood schoolage 5 10 years Often referred to as schoolage years Preadolescence Girls 911 Boys 10 12 Concerns for Children Poverty Lack of health insurance Unstable Families Low educational achievement Ethnic disparities in nutrition status Undemourishment Overweight and obesity Helping Hungry Children Twenty percent of Alabama s children live below the poverty level Secret Meals for Hungry Children Program through the Alabama Credit Union and local food banks Food packs are placed in student backpacks on the last day of school before a weekend or holiday All foods in the pack can be opened by a child and eaten without adult help Evaluating Growth Weight Average gain 7 lbs 335kgyear Height Average gain of 25 6 cmyear Growth Spurts Coincide with increased appetite intake Use growth charts for monitoring Evaluating BMIfor age gt95th percentile obese 85th95th percentile overweight Development Physiological T muscle strength motor skill stamina Body Fat increases at ages 663 and puberty De ned as BMI or Adiposity Rebound Earlier and T for females than males Earlier BMI Rebound occursthe greater the risk for future overweight Cognitive Child gains sense of self knowledge of what to do and ability to do it peer relationships are important Feeding Skills Have children help with meals Eating Behaviors In uenced by family peers teachers and coachesmedia Body Imageexcessive dieting in uenced by mothers controls and restrictive behaviors Early dieting may be risk factor for obesity Nutrient Needs Caloric needs Part of DRIs Based on child s gender age ht wt PAL Protein 95gkg for both boys and girls 413 Fiber 48 yrs 25gday Boys 913 yrs 31gday Girls 913 yrs 26gday Iron 10mgd for 48 yrs 8 mgday 913 yrs Calcium 800 mgd 48 yrs 1300mgd 913 yrs Encourage Fluids Children Sweat less Higher core temp during heat stress More Na and C1 in their sweat Teach good beverage choices Limit sugarsweetened beverages Flavored beverages during activity Screen Time Keep total screen time to lt2hrsday Televisions Video games Computers Keep tvs computers out of children s bedrooms Intervention Programs National Fruit and Vegetable Program WWWfruitsandveggiesmatter gov ChildNutritionPrograms National School Lunch Program School Breakfast Program Summer Food Service Program Chapter 14 and 15 ADOLESCENCE 0 Ages 11 21 0 Puberty Child becomes an adult 0 Sexual maturation Increases in height and weight 0 Accumulation of skeletal mass 0 Changes in body composition Age of onset duration tempo varies among individuals SMR Tanner Stages 0 Assesses degree of pubertal maturation and growth development regardless of chronological age on scale of 1 low to 5 high 0 Height Spurt Females 95 145 years peaks 6 12 mo before menarche 0 Average increase at peak 3 5 per year Males 105 175 years peaks 144 years ave age of spermarche linear growth may continue to 21 0 Average increase at peak 28 48 per year Menarche 0 Average age 124 range of 9 17 0 Delayed in highly competitive athletes or girls restricting kcalories Puberty starts earlier in African American girls but age of menarche is the same Changes in weight body comp and skeletal mass 0 Females Peak weight gain after linear growth aver 125 years 183 lb per year at peak Lean body mass decreases body fat increases to 27 body fat peaks at 15 16 years 17 body fat required for menarche 25 required for development and maintenance of regular ovulatory cycles 0 Males Peak weight gain coincides with peak linear growth and muscle mass accumulation about 144 years During peak aver weight gain of 20 lb per year Body fat decreases to 12 Three stages of psychosocial development 0 Early 11 14 Adjustment to new body impulsive behavior strong peer in uence 0 Middle 15 17 Separation growth mostly complete invinciblel more health risk behaviors heterosexual relationships 0 Late personal identity perceives consequences associated with behaviors Eating Habits Fluctuate 0 Meal Skipping Frequent snacking High in sugar sodium and fat 0 Less time With family 0 More fast food 0 About 1 choose vegetarian diets Some use as means of self denial and self control Overall Evaluation 0 De ciencies Folate Vitamins A B6 E Iron Zinc Calcium Fiber 0 Excesses Total fat Saturated fat Cholesterol Sodium sugar Recommendations 0 Energy Requirements based on htcm Females 11 24 2200 kcal Males 2500 3000 peak at 15 18 Almost all males 99 and 86 females meet energy needs Based on light to moderate activity Recommendations cont 0 Protein Expressed in gcm females 19 24 46 grams males 58 g ages 19 24 Highest at peak of height velocity 0 Carbohydrate 50 of total kcalories lt10 sugars actual consumption is 16 Fiber 05 gkg up to 36 g Recommendations cont 0 Fat No RDA but recc is 25 35 of total kcals 4 18 yrs of age 0 Calcium 1300 mgday for ages 9 18 0 Iron Needed most during male growth spurt and after menarche in females affected by SES Requirements for females ages 9 13 8 mgday 14 18 15 mgday and l8mgday for 19 50 yrs Men ages 9 13 8 mg 14 18 yrs 11 mgday 19 on 8 mgday Recommendations cont 0 Zinc Rises to 11 mgday for males ages 14 18 Rises to 9 mgday for females ages 14 18 and then drops down to 8 mgday Folate Rises to 400 mcg at ages 14 18 for both sexes Vitamins A and E Rise to adult levels at ages 14 18 0 Vitamin C rises to adult levels at age 19 90 mgday men 75 mgday women 35 mg smokers Speci c Concerns Overweight and Obesity 0 Hypertension and Hyperlipidemia Adolescent Athletes 0 Substance Abuse and Supplement Use 0 Adolescent Pregnancy 0 Eating Disorders Overweight and Obesity 0 Risk Factors At least one overweight parent Low income family African American Hispanic Native American Chronic or disabling condition Low level of physical activity High k caloriehigh fat diet Assessing Weight Status 0 Calculate BMI 0 Plot BMI for age using gender speci c growth charts 0 34 of US adolescents are overwt gt85th percentile but lt95th percentile 18 are obese gt95th percentile 0 Data from NHANES 2003 2006 Health Implications 0 Both medical psychosocial effects 0 Hypertension Dyslipidemia Insulin resistance 0 Type 2 Diabetes Mellitus 0 Sleep Apnea and other hypoventilation disorders Assessment and Treatment 0 Screen weight for height on annual basis 0 BMI for Age gt85th percentile 0 May require in depth medical assessment Eg Blood glucose Blood lipids Liver enzymes See Illustration 152 for triage guidelines De ne Vegetarian 0 Semi vegetarian Red meat 0 Laco ovo vegetarian Exclude meat poultry sh and seafoods Lacto vegetarian Exclude meat poultry sh seafood and eggs 0 Vegan Consume no animal products Adolescent Vegetarians 0 Approximately 4 of adolescents 11 report being vegetarian at some point during adolescence 0 Reasons include Cultural or religious beliefs health beliefs as a means to restrict calories or fat intake as a means to exert independence Adolescent Vegetarians o Adolescent vegetarians consumer more Fruits and vegetables Fewer sweets Fewer salty snack foods Less fat 0 Must monitor intake of protein calcium vitamin D B6 and B 12 Adolescents Vegetarians Adolescent vegetarians are more like to Report binge eating Twice as likely to report frequent or chronic dieting Four times more likely to report purging Eight time more likely to report laxative use 0 When compared to non vegetarian adolescents So what do we recommend 0 Adolescents can make their own choices 0 Assess their reason for becoming a vegetarian 0 Educate them on how to get the essential nutrients in that they may be missing out on 0 Ask questions to assess possible disordered eating Adolescent Pregnancy 0 Gynecological age Chronological age minus age at menarche GA lt2 may continue to grow during pregnancy 0 Likely nutrient de ciencies Calcium iron zinc magnesium folate Vitamins A E B6 Weight Gain Important Underweight increases risk for LBW SGA Poor weight gain in rst 24 weeks increases risk of SGA infant Poor weight gain after 24 weeks increases risk of preterm delivery Other Concerns 0 Iron De ciency Anemia Risks rapid growth inadequate intake of iron rich foods andor vit C restrictive vegetarian diets k calorie restricted diets meal skipping strenuous sports heavy menses 0 Hypertension Systolic and Diastolic Blood pressure levels increase with age to 95th tile of 14089 for boys age 17 and 13286 for girls age 17 What is an eating disorder It s not about food The most common element in all eating disorders is the lack of self esteem It is a psychiatric diagnosis caused by a variety of emotional factors and in uences It can be the result of POOR diet choices and unsuccessful dieting attempts 35 of normal dieters may progress to pathological dieting The Continuum of WeightRelated Concerns and Disorders Body dissatisfaction gt Dieting behaviors signi cant eating disorders gt Disordered eating gt Clinically Who suffers eating disorders 510 million girls and women 1 million boys and men 80 of American women say they are dissatis ed with their appearance 42 of 1st3rd grade girls want to be thinner 81 of 10 year olds are afraid of being fat Average American woman is 5 4 tall and weighs 140 pounds Average model is 5 11 tall and weighs 117 pounds Types of Eating Disorders amp DiagnosticCriteria Criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association 1994 Three categories of eating disorders source DSMIV Anorexia Nervosa AN with two subtypes AnoreXia Nervosa restrictive type and AnoreXia Nervosa Binge Purge type Bulimia Nervosa BN with two subtypes Bulimia Nervosa purging and nonpurging types Eating Disorder Not Otherwise Speci ed EDNOS Characteristics of AnoreXia Nervosa Refusal to maintain body weight of less than 85 eXpected Fear of gaining weight even though underweight Distorted image of body weight and shape Amenorrhea Two types of anorexia Restricting Binge eatingpurging Characteristics of Bulimia Nervosa May be of normal weight or even a little over weight Recurrent episodes of binge eating Recurrent inappropriate compensatory behaviors These behaviors occur at least twice weekly for 3 months Distorted view of body image Clinical depression Characteristics of BingeEating Disorder May be normal weight up to severely obese Recurrent episodes of binge eating at least twice weekly for 6 months Eating more rapidly than normal Eating until feeling uncomfortably full Eating large amounts when not hungry Eating alone or secretly Feeling disgusted depressed or guilty after eating Not associated with compensatory behaviors Other Types of Eating Disorders Compulsive Eating Compulsive Exercise What causes eating disorders Psychological Factors Low selfesteem feelings of inadequacy or lack of control in life Depression anxiety anger or loneliness Interpersonal Relationships Troubled family and personal relationships History of being teased about size or weight History of physical or sexual abuse What Causes Eating Disorders Social Factors Cultural pressures to be thin and possess the perfect body De nition of beauty that includes men and women of a specific weight Cultural norms that value people on basis of physical appearance not inner qualities BiochemicalBiological Factors Some Athletes at Higher Risk for Eating Disorders Sports that require weight control andor thinness for success Athletes may have Perfectionist tendencies competitiveness fear of failure Pressure from coaches and parents Strong desire to please Misconceptions about body size and performance Subjective judging in competitions The Female Athlete Triad Disordered Eating Weight loss Loss of body fat Amenorrhea Increased risk of infertility and other issues Primary amenorrhea menarche delayed beyond 16 years Secondary amenorrhea absence of 36 consecutive menstrual cycles Osteoporosis Increased risk of stress fractures Adolescent Athletes More focus on year round training in adolescents Few schools and youth sports associations have the funds for a Sports Dietitian Growth plates are susceptible to damage from excessive use Young athletes are not as efficient in movement as adults resulting in increase EE Energy requirements are not stable due to growth Nutrition knowledge is limited Rely on adultsparents for food Adolescent Athletes Nutrition Needs Energy EER for 918 year olds Protein 085 gkg Provide with practical tips for timing of uids and food pre and post training and events Fluid Intake 68 oz prior to exercise 46 oz every 1520 minutes during activity 8 oz following activity 16 oz for each pound lost during activity No more than 16 oz every 30 minutes gt avoid nausea Appropriate choices Sports drinks Other Concerns Low Carbohydrate Diets Dietary Supplements Creatine Protein Supplements Protein requires water for breakdown can promote dehydration Chapters 16 and 17 Adulthood 0 Early Adulthood 2040 0 Midlife 4060 0 Older Age 60 and older 0 Nutrition Goal 0 To develop the most powerful nutrition habits possible Physiological Changes of Adulthood o Males 0 May have some growth in early 20 s 0 Develop bone density until 30 o Midlife shift in body composition 0 Testosterone declines age 4050 0 Females 0 Develop bone density until 30 o The big M Menopause Three major health issues 0 Reproduction 0 General Wellness 0 Weight Management 0 At age 40 men begin to gain 066 lb per year 0 At age 40 women begin to gain 121 lbyear Weight Management 0 Calculate energy needs 0 HarrisBenedict dev 1919 o Mif inSt Jeor dev 1990 O Hamwi EER used to calculate DRIs Determining Energy Needs 0 Factors that impact needs 0 Genderbody size ht wtmuscle mass 0 Age 0 Activity level 0 Health status 0 Hormones 0 Individual variation Where does the energy go Thermogenesis o BasalMetabolism about 23 0 Voluntary Physical Activities about 13 0 Thermic Effect of Food 10 0 Adaptive thermogenesis when body has to work extra hard to adapt to extreme conditions Factors that affect the BMR Raise It Younger Age Lean Tissue Growth Fever and Stresses Environmental Temp Thyroxin Smoking Caffeine Lower It 0 Older Age 0 Fat Tissue O Fasting o Starvation O Thyroxin How much energy do I need every day 0 Depends on O Basal Metabolic Rate BMR O Formulas consider age gender weight height 0 Physical Activity 0 Tables consider average daily level of activity or energy spent for speci c physical activities Estimating vs Measuring Energy Needs 0 Goals for feeding pts are derived from estimates or measurements of their energy expenditure 0 Concerns with estimating needs 0 Basal Metabolic RateBMR vs Resting Metabolic Rate RMR 0 Indirect calorimetry practical application for clinical setting 0 What about outpatient setting Estimating vs Measuring Energy Needs The MedGem BodyGem o The MedGem indirect calorimeter a FDA 510Kcleared Class 11 medical device is a handheld device that measures oxygen consumption V02 to determine resting metabolic rate RMR RMR is calculated using the Weir equation and a constant RQ value of 085 RMR6931XVO2 Weir J B New Methods for Calculating Metabolic Rate with Special Reference to Protein Metabolism J Physiol 1949 109pages 19 Hamwi Formula 0 Males 106 lbs for first 5 of height 6 lbs for each inch over 5 0 Females 100 lbs for first 5 in height 5 lbs for each inch over 5 o For small frames deduct 10 For large frames add 10 The HarrisBenedict Equation 0 Developed in 1919 o Derived from 239 subjects aged 1274 0 Re ects resting metabolic rate RMR by today s standards not basal metabolic rate BMR HarrisBenedict Formula males RMR 665 1375 X wt 5 X ht 68 X age females RMR 655 96 X wt 18 X ht 47 X age Note Wt in kg hr in cm age in years The MifflinSt Jeor Estimation Formula 0 Developed in 1990 consider differences in body size circa early 1900s vs today 0 More accurate than HarrisBenedict 0 Look to validation studies 0 Energy estimation formulas within 10 of the true RMR are considered accurate 0 Accuracy rates 0 Mif inStJeor 82 o HarrisBenedict 69 Mif inSt Jeor Formula Note Wt in kg hr in cm age in years males RMR 10 X wt 625 X ht 5 X age 5 females RMR 10 X wt 625 X ht 5 X age 161 Calculate the Body Mass Index 0 BMI Formula weight kg height m2 0 BMI lt185 underweight 0 BMI 185249 healthy weight 0 BMI 250299 overweight 0 BMI gt30 obese Basic Weight Loss Principles 0 For each 3500 k calories eaten in excess a pound of body fat is stored 0 Safe rate of weight loss 0 12 21b per week or 10 of body weight in 6 months Adult Weight Management 0 Criteria for choosing weight control programs 0 Program claimsdesignoutcomes 0 Therapeutic approach 0 Watch for quick f1xesgallbladder complications Describe3 modes of therapy 0 Lifestyle 0 Pharmacotherapydrug intervention 0 Surgical Dieting for Weight Loss 0 Calories In Calories Out Weight Change 0 Calories do matter 0 But excess calories can be negated by increased energy expenditure 0 Vitamin and mineral supplementation cannot make up fully for empty calories nutrient poor foods 0 Diet composition matterstoo 0 Encourage low energy dense foods Guidelines for Use of Drugs NIH Consensus Panel 0 Drugs will not eliminate the need to change lifestyle 0 Should be considered only after 46 months of lifestyle therapy 0 Should be considered as an adjunct to lifestyle therapy only for persons with 0 BMI 30 with no comorbidities or risk factors 0 BM127 with comorbidities or risk factors 0 Hypertension dyslipidemia abnormal lipids coronary heart disease Type 2 diabetes sleep apnea Surgery 0 For severely or morbidly obese patients only 0 BMIZ 40or2 35 with signi cant comorbidities 0 After serious attempts at lifestyle modi cation 4 o RouXenY gastric bypass O Banding vertical gastroplasty amp gastric banding o Gastric Sleeve or gastric sleeve resection RESTRICTION 0 Surgery patients will have a pouch instead of a stomach o It will be the size of an egg 0 It will hold about a 12 cup of food 0 The pouch restricts the amount of food patients can eat MALABSORPTION 0 Patients need to get enough protein 50 60 gms per day 0 Patients will need to take Multivitamins for the rest of their lives 0 This will start from DAY ONE Laparoscopic Adjustable Band Surgery 0 A port is placed under the skin during the operation 0 Saline can be added or withdrawn from the Band depending on speed of weight loss and symptoms 0 This surgery restricts consumption but does not cause malabsorption Gastric Sleeve Surgery 0 Surgeon removes approx 85 of the stomach O Stomach looks like a tube or sleeve 0 May be followed by gastric bypass in 6 to 18 months 0 Considered a staged approach to bariatric surgery Diet Composition 0 Diets high in the following are associated with higher disease risk 0 Saturated fat 0 transfat 0 Cholesterol 0 Re ned grains 0 Diets high in the following are associated with lower disease risk oFm o FruitsVegetables o Unsaturated fats O Wholegrain O Proteinvegetable lean Diet Composition 0 Reducing fat intake replacing with carbs 0 Is an efficient way to lower calorie intake 0 Improves total cholesterolinsulin resistance 0 Reducing carbohydrate intake replacing with fat 5 O Improves triglyceridesandtotal cholesterol HDL O Leads to more rapid initial weight loss Diet Composition 0 Reducing carbohydrate intake replacing with protein 0 Improves maintenance of lean body mass during weight loss 0 Improves lipids If you do nothing else 0 Encourage selfmonitoring 0 Writing down what you eat makes you more selfaware 0 One behavioral strategy strongly correlated with maintenance of weight loss 0 Promote stimulus control change individual environments that lead to overeating 0 Set goals realistic goals 0 Stay informed Look for sound science and ght misinformation Nutrition and Chronic Diseases 0 Four of the top ten causes of death are related to diet 0 There are also genetic and lifestyle risk factors that are important and related to chronic disease 0 Many of the nutritional factors in the treatment of chronic disease are interrelated Factors that in uence disease 0 Physical inactivity O Overweight 0 Tobacco Use 0 Alcohol and Drug Abuse 0 Irresponsible Sexual Behavior 0 Genetics 0 Age 0 Gender 0 Ethnicity Risk Factors for Cardiovascular Disease 0 Modifiable 0 High Blood Cholesterol 0 Hypertension 0 Diabetes Insulin ResistanceObesity 0 Physical Inactivity 0 Smoking 0 Non modifiable 0 Gender Age Family History Dietary Recommendations for Reducing CVD Risk 0 ControlWeight 0 Reduce Fat 0 Total Fat 0 Saturated Fat 0 Dietary Cholesterol 0 TransFattyAcids 0 Increase some fats O Omega3Fatty Acids 0 Monounsaturated Fats 0 Moderate alcohol consumption 0 Increase 0 Soy o B6B12 o VitE O SolubleFiber Hypertension O Maj or contributor to heart attacks and strokes O Develops through kidney response obesity insulin resistance 0 Usually cannot feel the physical effects 0 Aneurysms can be fatal Risk Factors for Hypertension 0 Smoking 0 High blood lipids 0 Diabetes 0 Gender 0 Age 0 Genetics 0 Obesity 0 Ethnicity Recommendations 0 WeightControl O PhysicalActivity 0 Moderate alcohol consumption 0 Moderatesodiumsalt intakelt230024OO mg sodium 0 Salt sensitive groups are African Americans elderly people with hypertension or diabetes 0 The DASH Diet High in fruits and vegetables low in fat less meats emphasis on lowfat dairy Cancer Four leading malignancies Colonrectal cancer 0 Heavy alcohol red meat increase risk have regular exams at age 50 Prostate and Testicular Cancer 0 regular selfexams regular exams at age 50 Breast Cancer 0 Mammograms at age 40 routine selfexams know family history Lung Cancer 0 Avoid cigarette smoke Cancer Prevention Tips 0 Choose Whole grainslegumesstarchy vegetables 0 Minimum 5 servings of fruits and vegetables 0 Limit processed foods and re ned sugar 0 Maintain healthy weight 0 Make exercise a part of everyday Cancer Prevention Tips 0 If you drink do so in moderation Serving sizes of alcohol 0 12 oz beer 0 5 oz Wine 0 112 oz liquor 0 Tip consider the size of Wine glasses beer mugs etc 0 Choose food low in fat and salt Cancer Prevention Tips 0 Limit red meat 0 Don t char foods on the grill 0 This can create carcinogens that are later detoxi ed by the liver 0 Prepare and store foods safely 0 StopsmokingcheWingspittingdipping no tobacco Diabetes Mellitus o Typel 510 0 Type 2 9095 0 Blood glucose control helps reduce the impact of several complications Type 1 Diabetes 0 An auto immune disorder olmmune system attacks and destroys beta cells in pancreas where insulin is produced 0 Without insulin the cells cannot take in glucose 0 Insulin delivered by pump or by injection 0 symptoms 0 Weight loss no energy thirsty hungry Type 2 Diabetes 0 A metabolic disorder OPancreas produce insulin but it is not effective with moving glucose into cells 0 This is known as insulin resistance 0 Medication OHA s oral hyperglycemic agents and sometimes insulin 0 Symptoms O Hunger weight gain thirsty Complications of Chronic Uncontrolled Diabetes 0 Blindnessretinopathy O Nerve damageneuropathy 0 Heart diseasecardiovascular disease 0 Kidney diseaserenal disease Dietary Recommendations 0 Typel 0 Maintain blood glucose within normal range 0 Must coordinate diet physical activity and insulin 0 DietConsistent carbohydrate daily at each meal and snack heart healthy fats moderate protein 0 Type2 0 Diet Consistent carbohydrate controlled fat intake 0 Lose weight Chapters 18 and 19 Life Expectancy o In the US 78 years 0 Compare that to 1900 47years o Longer life span due to immunizations disease prevention and treatment 0 By 2050 1 of US population expected to be centenarians 100 yrs Nutrition in Aging Aging Process Rate of catabolic change gt anabolic change Net result functional capacity of cells organs and tissues Aspects of Aging 0 Physical o Emotional 0 Social 0 Economic O Spiritual Theories of Aging Gerontology the study of aging Theories ascribe aging to either random events or programmed consequences under genetic or neuroendocrine control What Causes Aging 0 Genetics Diet Environmental Factors 0 Theories of Aging 0 ProgrammedAging 0 Cells die When they can no longer divide telomeres 0 Wear and Tear O Oxidative stress rate of living 0 Caloric Restriction PROLONGS life Changes Associated With Aging Process 0 Progressive loss of LBM O Sensory decline 0 Oral Health changes 0 GI changes 0 Metabolic changes 0 CV changes 0 Renal function 0 Musculoskeletal changes 0 Neurologic changes 0 Immune fX decrease o Psychosocial changes Progressive loss of LBM Loss of skeletal muscle sarcopenia As people age activity declines fat tissue replaces lean REE Loss of strength and coordination accompanies loss of lean tissue can ultimately affect ability for ADL s including many activities associated with adequate food intake Sarcopenia 0 What is it A normal detrimental loss of muscle with aging Who s at risk Everyone Higher risk factors 0 physical inactivity O inadequate or inappropriate nutrient intake 0 chronic health issues Sensory decline Taste smell sight hearing touch taste dysgeusia May be 20 to medical conditions or medications Taste amp smell affect other metabolic processes e g salivation amp gastric acid production Poor vision amp hearing affect food intake Oral Health Changes Xerostomia dry mouth involves up to 70 of older adults Affects food intake and oral health Significant decay peridontitis toothbone loss Edentulous state or dentures GI Changes Dysphagia can choking risk Hypochlorhydria Atrophic Gastritis Incr gastric pH amp bacterial overgrowth decreases Ca and B12 absorption Constipation 20 GI motility uid intake inactivity Metabolic Changes in glucose tolerance 2O insulin insensitivity in BMR 2O decr LBM Cardiovascular Changes Loss of vascular elasticity results in increased prevalence HTN requires medication to decrease stroke risk Renal Function Associated with chronic medical conditions e g HTN DM Reduced concentrating ability means more uid is lost some protein is lost management of electrolytes and metabolic wastes is compromised Musculoskeletal changes Total body proteins somatic amp visceral 3040 less in elderly Results BMR insulin sensitivity appetite breathing ambulation mobility amp independence Bone density leads to osteoporosis fractures and loss of stature Neurologic changes Change in CNS neurotransmitters andor organic destruction sleep disturbances depression mild confusion to Alzheimer s Disease Depression is common and associated with failing health loss of independence CNS atrophy senile dementia Immune function changes Increased susceptibility to infection and possibly malignancy Psychosocial changes Isolation depression fear contribute to general overall decline including nutritional issues Nutrition Assessment 0 Best practice multidisciplinary assessment MD PA RN RD CDM SW PT OT SLP psychologist activities director This model has been embraced successfully in long term care 0 Selfassessment is encouraged by the Nutrition Screening Initiative with the DETERMINE checklist Energy Needs Assessment Kcal intake 1600 and up consider if older adult is sedentary vs physically active do screen for unintentional wt loss Protein Needs Assessment 1 Elderly need a greater proteincalorie ratio 20 to Changes in body composition body proteins are only 607 0 of that in young persons Remember Sarcopenia 2 Protein metabolism is less ef cient 3 Protein utilization is less ef cient Dif cult to maintain N balance with lt1 gkg Good recommendation ll3 gkg BW 0 Risk factors for poor protein intake include poor dentition swallowing problems decline in mentation or ADL s limited income and self restriction of animal productscholesterolfat 0 Things that increase protein requirements stress illness surgery infection steroid therapy pressure ulcers or other chronic wounds Fluid Needs Assessment 0 Dehydration most common cause of uid amp electrolyte disturbances and hospitalization 2O 1 Decreased thirst amp decreased uid intake 2 Decreased water conservation by kidney 3 Frequent use of diuretics and laxatives 4 Incontinence Encourage 6 or more glasses of uidday to prevent dehydration and resulting confusion weakness altered drug metabolism Or lmL uidkcal consumed minimum 1500 mL Additional Considerations Nutrient intolerances that may develop with age glucose Type 11 DM lactose lactose intolerance lipid hypertriglyceridemia or hypercholesterolemia Mineral needs decrease as LBM decreases but may need Ca 20 bone loss and Zn 20 decrease intake RDA Ca 1200 mgd for men amp women gt51y Zn 8 mgd women 11 mgd men Additional Considerations Sodium may need to be decreased to 24 gd for tX of HTN in those who are saltsensitive or on diuretics Potassium may need to be supplemented in those on potassiumwasting diuretics Magnesium may also need to be supplemented with diuretics Antioxidant capacity of vitamins C E amp A may provide protection against cellular damage leading to cancer heart disease and cataracts Vitamin C needs are increased by smoking stress some meds Foods rich in these vitamins should be included daily in the diet Vit D supplementation may be appropriate for institutionalized or homebound individuals with poor dietary intake In complete lack of sunshine give 400 IUd Calcium supplements should contain vit D B 12 supplement needed for those with atrophic gastritis B6 and folate are frequently insuf cient Vitamin mineral and herbal supplements are commonly taken by older people to stay healthy Pts should be cautioned re potentially toxic doses The Bottom Line To facilitate the best possible intake of nutrients from foods restrict the diet as little as possible Special Issues Dysphagia may develop after strokes brain injury or dementia Requires manipulation of food beverage textures for safe swallow Pressure Ulcers common in those confined to wheelchairsbeds or unable to position themselves 0 Risks increase with diabetes incontinence malnutrition neuro or circulatory impairment MNT High kcal high protein diet with vit C and zinc supplementation incr uids 0 Alzheimer s Disease cognitive and physical deterioration result in decreased feeding skills and poor recognition of personal needs 0 Parkinson s Disease loss of voluntary movement may affect chewing swallowing ability self feeding skills and disease is associated with increasing levels of confusion 0 Failure to Thrive General decline in all body systems body cell mass immune system cognitive and functional capacity Support Services 0 Communitybased food amp transportation programs are administered by govt private nonprofit and volunteer organizations 0 Assisted Living offer safe environment which supports independent living 0 Skilled Care Nursing Facilities for those whom independent living is no longer possible Facilities are certified by Centers for Medicare and Medicaid Services CMS
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