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by: Regan Dougherty

NHM201ch16&17.pdf NHM 201

Regan Dougherty
GPA 4.0

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Chapter 16 and 17 notes
Nutrition Through the Lifecycle
Denise DeSalvo
Class Notes
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This 9 page Class Notes was uploaded by Regan Dougherty on Thursday November 19, 2015. The Class Notes belongs to NHM 201 at University of Alabama - Tuscaloosa taught by Denise DeSalvo in Summer 2015. Since its upload, it has received 33 views. For similar materials see Nutrition Through the Lifecycle in Nutrition and Food Sciences at University of Alabama - Tuscaloosa.

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Date Created: 11/19/15
Thursday, November 12, 2015 Adult Nutrition Chapters 16 & 17 - Adulthood goes until about 64 years old. • Early adulthood - 20-40 • Midlife - 40-60 • Older age - 60+ - 5 of the 10 leading causes of death (cancer, heart disease, stroke, diabetes, liver disease) are affected by nutrition and lifestyle choices. - Physiological Changes of Adulthood • Growing stops by 20’s. • Bone density continues until 30. • Muscular strength peaks around 25-30. • Decline in size and mass of muscle and increase in body fat. • Dexterity and flexibility decline. • Hormonal and Other Critical Changes - Women • Menopause: decline of estrogen • increase of abdominal fat (change in body fat distribution) • increase in risk of cardiovascular disease (because of increase of abdominal fat) and accelerated loss of bone mass - Men • gradual decline in testosterone level and muscle mass • Body Composition Changes in Adults - Bone loss begins around age 40. - A positive energy balance results in increase in weight and adiposity and decrease in muscle mass. 1 Thursday, November 12, 2015 - Fat redistribution - gains in the central and intra-abdominal space, decrease in subcutaneous fat • associated with an increased risk of chronic disease: hypertension, insulin resistance, diabetes, stroke, gallbladder disease, coronary artery disease - 3 Major Health Issues • Reproduction • General wellness • Weight management - At age 40, men begin to gain 0.66 lb per year. - At age 40, women begin to gain 1.21 lb per year. - Energy Needs • Estimated based on BMR + Activity + TEF - Basal Metabolic Rate (BMR) - considers age, weight, gender, height • basic life functions • makes up about 2/3 of caloric needs - Activity • most variable component (20-40% of caloric needs) - Thermic Effect of Food (TEF) • metabolism of food • about 10% of caloric needs • Estimated Energy Needs - calculate REE energy needs • Harris-Benedict - reflects resting metabolic rate (RMR), not BMR - formulas for males and females (weight in kg, height in cm, and age in years) - factor in activity 2 Thursday, November 12, 2015 • Mifflin-St. Jeor - also reflects RMR - formulas for males and females (weight in kg, height in cm, and age in years) - more accurate than Harris-Benedict (but these calculations are still only estimates; you are never going to be exact) • Hamwi - just be aware of this method - “ballpark,” not specific/exact - Nutrient Recommendations • Fat - 20-35% of calories • Carbs - 45-65% of calories • Protein - 10-35% of calories • Risk Nutrients - fiber (lack of fiber associated with lack of fruits and vegetables; higher fiber associated with nutrient dense diet; cholesterol) - vitamins A and E (antioxidants) - vitamin D and calcium (bone health) - folic acid - B12 - choline - magnesium - potassium and sodium (fluid and electrolyte balance/blood pressure) • Dietary Recommendations - Dietary guidance systems (ex. MyPlate) - dietary and lifestyle recommendations - Weight Treatment Pyramid: lifestyle modification is the first and most widely-used step, then pharmacotherapy, surgery is a last resort. 3 Thursday, November 12, 2015 - Energy Adjustments for Weight Change • 1 lb of body fat = 3500 calories • Safe rate of weight loss: 1/2 - 2 lb per week or 10% of body weight in 6 months - Dieting for Weight Loss • Vitamin and mineral supplementation cannot make up fully for empty calorie/ nutrient poor foods. - 3 Modes of Therapy for Weight Management • Lifestyle Changes/Lifestyle Therapy - Reducing fat intake (replacing with carbs) • is an efficient way to lower calorie intake. • improves total cholesterol and insulin resistance. - Reducing carbohydrate intake (replacing with fat) • improves triglycerides and total cholesterol (HDL). • leads to more rapid initial weight loss. - Reducing carbohydrate intake (replacing with protein) • improves maintenance of lean body mass during weight loss. • improves lipids. • Drugs do not eliminate the need for lifestyle change. - should only be considered after 4-6 months of lifestyle therapy - should be considered in addition to lifestyle therapy (lifestyle change) if: • BMI > 30 with no co-morbidities/risk factors • BMI > 27 with co-morbidities/risk factors Surgery • - is only suggested for severely/morbidly obese people (BMI > 40 (no co- morbidities) or BMI > 35 with significant co-morbidities). • after serious attempts at lifestyle modification 4 Thursday, November 12, 2015 - Roux-en-Y gastric bypass - Banding - vertical gastroplasty and gastric banding - Gastric sleeve or gastric sleeve section - Usually, surgery patients will have a pouch instead of a stomach. • size of an egg, hold ~1/2 cup of food - Problems After Surgery making sure patients get enough protein • • malabsorption (patients will need to take multivitamins for the rest of their lives.) - Chapter 17: Conditions and Interventions • Factors that influence disease: physical inactivity, overweight, tobacco use, alcohol/ drug abuse, irresponsible sexual behavior, genetics, age, gender, ethnicity • Diet Composition: - Diets high in the following are associated with higher disease risk: • saturated fat, trans fat, cholesterol, refined grains/sugars - Diets high in the following are associated with lower disease risk: • fiber, fruits/vegetables, unsaturated fats, whole grains, protein (vegetable, lean) • Risk Factors for CVD (cardiovascular disease) - Modifiable • high blood cholesterol, hypertension (blood pressure), diabetes (insulin resistance)/obesity, physical inactivity, smoking - Non-modifiable • gender, age, family history • Blood Lipid Levels - Total Cholesterol: desirable: < 200; high: > 240 - LDL: desirable: < 100; high: 160-189 - HDL: desirable: > 60; low: < 40 5 Thursday, November 12, 2015 - Triglycerides: desirable: < 150; high: 200-499 • Blood Pressure: desirable: < 120/80; high: >140/>90 • Dietary Recommendations for Reducing CVD Risk - control weight - reduce fat (total fat, saturated, dietary cholesterol, transfatty acids) - increase some fat (omega 3 fatty acids, monounsaturated fats) plant and fish sources • - moderate alcohol consumption - increase: soy, B6, B12, vitamin E, soluble fiber • Nutrition Interventions for CHD (congestive heart failure) - total fat intake from 25-35% of calories • saturated fat < 7% of calories • monounsaturated fat up to 20% of calories • polyunsaturated fat up to 10% of calories • trans fat <1% of calories - dietary cholesterol < 200 mg/day - carbohydrates from 50-60% of calories - dietary fiber 20-30 g/day • 5-10 g viscous - weight reduction for overweight/obese - > 200 calories spent on physical activity each day • Hypertension - major contributor to heart attack and stroke - develops through kidney response, obesity, insulin resistance - People with hypertension usually cannot feel the physical effects. - Aneurysms (the walls of a blood vessel weaken and can burst) can be fatal. 6 Thursday, November 12, 2015 - risk factors: smoking, high blood lipids, diabetes, gender, age, genetics, obesity, ethnicity • African Americans tend to have more incidents of hypertension than any other ethnic group. - recommendations: weight control, moderate alcohol consumption, moderate sodium intake (< 2300/2400 mg sodium) • Sodium has to do with intracellular and extracellular fluid balance. • African Americans, elderly, people with hypertension or diabetes are “salt sensitive” groups • DASH diet: high in fruits/vegetables, low in fat, less meats, emphasis on low- fat dairy • Cancer - Colon, prostate, breast, and lung are four leading types. - Cancer is associated with a change in DNA. Cancers generally start in an epithelial cell (lining cells). - Prevention Tips: • Choose whole grains, legumes, starchy vegetables. • minimum of 5 servings of fruits and vegetables • Limit processed food and refined sugar. • Maintain a healthy weight. • Exercise daily. If you drink, do so in moderation. • • Choose food low in fat and salt. • Limit red meat. • Don’t char foods on the grill. • Prepare and store foods safely. • no tobacco • Diabetes 7 Thursday, November 12, 2015 - Two kinds: type 1 and type 2 - Blood glucose control helps reduce the impact of several complications. - risk factors: parent/sibling with diabetes, history of gestational diabetes, elevated A1c / IFG / IGT, racial/ethnic background, sedentary lifestyle, hypertension, low HDL, high triglycerides, CVD - Type 1 • Autoimmune disorder (immune system attacks and destroys beta cells in the pancreas where insulin is produced) Without insulin, the cells cannot take in glucose. • - Type 2 • Metabolic disorder (pancreas produces insulin, but it is ineffective) - Complications: blindness (retinopathy), nerve damage (neuropathy), CVD, kidney disease - Dietary Recommendations • Type 1: maintain blood glucose within normal range; coordinate diet, physical activity, and insulin (diet - consistent carbohydrate daily (at each meal or fat), heart healthy fats, moderate protein) • Type 2: diet (consistent carbohydrate, controlled fat intake), lose weight - Metabolic Syndrome • metabolic abnormalities that increase the risk of type 2 diabetes • diagnosis (3 of the following) - abdominal obesity (waist circumference) - increased blood insulin - increased fasting glucose - increased triglycerides - increased blood pressure - decreased HDL • Overweight and Obesity 8 Thursday, November 12, 2015 - can lead to chronic inflammation and insulin resistance. - generally leads to shorter life spans. - is not solely due to overconsumption. - See Table 17.2. • Waist circumference also contributes to the risk of developing a chronic illness. - Exceptions for Use of BMI BMI measures don’t accurately represent healthy weights of people who are: • - athletes with increased muscle mass. - with decreased muscle mass - dense, large bones - dehydrated or over hydrated • Weight loss programs tend to be more successful if: - they are 3-4 months in duration. - they build knowledge (teach new behaviors). 9


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