Exam 4

Estrogen's Protective Effects

Estrogen decreases: Hepatic production of cholesterol (lowers enzymes) Contraction of smooth muscle cells Homocysteine levels Estrogen Increases Hepatic LDL catabolism Insulin sensitivity Stimulates release of nitric oxide

Prevalence of Heart Disease

In 2000, there was in mortality 24% decrease for HD 10% decrease for stroke 2015 CDC- 1 in 4 deaths (610,000 per year) HD linked to deaths 3rd leading cause in 25-44 y/o 2nd leading cause in 45-64 y/o 1st leading cause in >65 y/o

Weight Gain

Mean body weight gradually increases with aging, peaking between 50 & 59 yrs

80/10/10 Diet

Often seen with vegan/raw type diets Concerns with pregnancy DHA, B12, vitamin D, iron, etc. Gene expression

Other Types of ED

Pregorexia- weight restriction, excess exercise Media driven (focus of weight loss after birth) SED (selective eating disorder)

Rehydration

Rehydrate slowly Guidelines Provide 1/4 to 1/3 overall fluid deficit Use water of 5% glucose solution Thickened liquids count as fluid Offering fluids hourly and with medication - achieve higher levels of hydration Dehydration at end of life ~ overall slowing down of body systems

Physiological Changes in Females Menopause

With cessation of menstruation, iron needs Daily Iron Requirement decreases to 8 mg Loss of estrogen effects: Urinary tract & vagina Heart Bones HRT Male Menopause

HDL

high density lipoproteins good cholesterol

Prognosis for People with Anorexia Nervosa

~4% die from the disease Deaths related to weakened immune system, gastric ruptures, cardiac arrhythmia, heart failure, & suicide Early diagnosis & treatment improves chances for recovery Recovery rates <50% fully recover ~33% show improvement ~20% chronically affected

Alcohol

~61% if U.S. adults drink alcohol ,1 and 2 rule Nations vary on alcohol consumption guidelines U.S. guidelines are "If you drink, do so in moderation" The Canadian guide states that >4 drinks at a time are risky

Vitamin D Council

1-70 600 IU 71+ 800 IU

Alcohol and Breast cancer

10/2015, International Journal of Cancer 334,000 women aged 35 to 70, across 10 European countries. Nearly 12,000 of the women developed breast cancer over the study period. risk of breast cancer quadrupled with each daily glass of wine or beer. The study wasn't designed to prove cause-and-effect, however, only to show an association. Breast cancer risk was stronger among women who started drinking prior to first pregnancy. Ethanol stimulates both cell proliferation and estrogen receptor signaling in the mammary gland.

LDL cholesterol level

100-129 near 130-159 borderline high 160-189 high 190 very high

Hypertension: Nutritional Remedies

2 main strategies: Maintaining healthy weight Reducing sodium to <1500 mg/d The new DGA also state that for individuals with prehypertension and hypertension "further reduction to 1,500 mg per day can [emphasis added] result in even greater blood pressure reduction." Other recommendations Moderation in alcohol Adequate potassium (4700mg), magnesium, & calcium intakes Following MyPyramid & DASH guidelines

Saturated FAT

2010 Harvard review article (Micha R, Mozaffarian D) replacing SFA with polyunsaturated fat modestly lowers coronary heart disease risk, with ~10% risk reduction for a 5% energy substitution; whereas replacing SFA with carbohydrate has no benefit and replacing SFA with monounsaturated fat has uncertain effects Issues with recommending "Avoid Saturated Fat" Replace with PUFA not CHO TC:HDL ratio is decreased by lauric acid but not palmitic acid

Almonds

2016 review (Journal of Nutritional Science) concluded almonds (45 grams per day= 2 servings= 2 oz) can lower LDL, total cholesterol and Triglycerides without harming HDL 1 cup = 105 grams I oz of almonds has 13 grams unsaturated fat 1 gram of saturated fat, 6 grams of protein, 4 grams fiber

Adults and ADHD

30-70% of children with ADHD retain attention related symptoms into adulthood Behavioral and Diet Treatments Avoid processed foods

Kidney Stones

5% of the world's population Stones= calcium and oxalate or phosphate Causes: low fluid intake, low calcium intake, excess body weight (uric acid stones), diabetes, foods high in oxalate (spinach, rhubarb, tea, chocolate, nuts, strawberries)

Prevention

A healthy diet should have a positive impact on health and not affect relationships with other people or quality of life and emotional states Orthorexia should be treated as a disorder concerning abnormal eating behavior that is linked with obsessive-compulsive symptoms Groups of people who may be at a higher risk for ON include athletes, medical students and professionals, and artists. There does not seem to be a significant difference between prevalence of ON in men and women. Proper nutrition education and avoiding classifying foods as "good" and "bad" may help prevent ON.

Treating Eating Disorders

A multidisciplinary team approach Team may consist of Physician Nutritionist Nurse Psychologist Psychiatrist

Hypertension: Prevalence and Etiology

AHA 2013: 77.9 million (1 out of every 3) adults have high blood pressure Only about half (52%) of people with high blood pressure have their condition under control.1 Nearly 1 of 3 American adults has prehypertension blood pressure numbers that are higher than normal, but not yet in the high blood pressure range. 64% of Americans with HTN have it under control Etiology Family history African Americans ~20% of cases linked to salt intake

Added Sugar Recommendations

AHA- 100 calories/25g/6 tsp for a woman, 150 calories/38g/9 tsp for a man 1 donut- 5-7 tsp, starbucks grande latte- 5 tsp, 1 DD coffee cake muffin= 14.5 tsp, 20 oz soda- 16 tsp, 6 oz strawberry yogurt- 3 tsp Natural sugars not a concern (except for juice)

Body Dissatisfaction

Adolescents with low levels of body satisfaction are more likely to use unhealthy weight control behaviors & participate in less physical activity

Water and Other Fluids

Adults can survive 3-4 days without water Fluid intake recommendations are 1 mL/kcal consumed At least 1500 mL if < 1500 kcal consumed In the average person, water in foods accounts for ~19% of fluid with ~81% from beverages Diuretic effects of caffeine and alcohol While caffeine does act as a diuretic, the DRI committee concluded caffeine-containing beverages contribute to the total daily water intake (maximum 400 mg)

Osteoarthritis

Affects ~7% of population, more common in men Etiology—cartilage loss, bone changes, hardening of soft tissues & inflammation Risk Factors Treatment- glucosamine with chondroitin (????) GAIT trial showed similar effects with placebo users- may help moderate to severe pain only, vitamin C/D (????)

Maintaining a Healthy Body

Age-Related Changes Caloric expenditure declines ~2% per decade during early adulthood Due to ddecrease in metabolic rate & decrease activity level Physical working capacity declines 5-10% per decade in older adults Declines accelerated with musculoskeletal disease, obesity and other conditions

Theories of Aging

Aging theory tries to explain physical & mental changes that accompany aging Theories fall into 3 groups Programmed aging Wear & tear theories Calorie restriction & longevity

Alzheimer's Disease 5.1 million $450,000,000 Autism 3.6 million $160,000,000 Schizophrenia 3.4 million $276,000,000 Eating disorders 30 million $28,000,000

Almost 50% of people with eating disorders meet the criteria for depression ED have the highest mortality rate for any mental disorder. Every hour a person dies from an eating disorder

Soy and Breast Caner Risk

American Association for Cancer Research (AACR) Annual Meeting 2015 Study in mice found genistein's ability to activate anti-tumor immune responses and reduce expression of immunosuppressive mechanisms may explain why lifetime genistein intake reduces risk of breast cancer recurrence critical that genistein is consumed well before a tumor develops to program the tumor to exhibit good immune responses Target at least 10 mg isoflavones daily (1/3 cup soy milk)

What is Orthorexia?

An obsession with eating foods that one considers healthy. Literal translation of Orthorexia: "righteous eating" or "correct appetite" Term coined by Steven Bratman, M.D. in 1997 Parallels with Anorexia Nervosa and Obsessive Compulsive Disorder There is no formal diagnosis criteria for Orthorexia

Treatment for CAD

Angina that is not life threatening- drugs, diet Angioplasty- narrowed arteries are dilated with a balloon so blood can flow more easily laser angioplasty Stents- short mesh tube made of wire used to prop open coronary arteries after angioplasty must take blood thinners to discourage clot formation Coronary Artery Bypass (CABG)- veins or arteries are used to bypass clogged or blocked arteries-improves blood supply to heart

Three Main Eating Disorders

Anorexia nervosa -Characterized by extreme wt loss, poor body image, & irrational fears of wt gain & obesity Bulimia nervosa -Characterized by recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time frequently followed by purging Binge-eating disorder -Characterized by periodic binge eating not followed by vomiting or use of laxatives

tea (camellia sinensis)

Antioxidants Tea 400-600mg White Tea 300-400mg Jasmine Tea[1] 300-450mg Green Tea 130-200mg Black Tea 60-80mg Rooibos 'Tea'[2] ? (low) Instant Tea 20-110mg Iced tea

Changing Sensual Awareness: Appetite and Thirst

Appetite: Hunger & satiety cues weaken with age Older adults may need to be more conscious of food intake levels since appetite-regulating mechanisms may be blunted Thirst:: Thirst-regulating mechanisms decrease with age Studies support that dehydration occurs more quickly after fluid deprivation & rehydration is less effective with advancing age

Nov 2013- FDA proposes a ban on trans fats

Banning them completely could prevent 20,000 heart attacks and 7,000 deaths from heart disease each year No longer on GRAS list Ban is only for added not natural sources (meats) June 2015- officially banned

Etiology of HD

Begins when substances like cholesterol, fatty acids & calcium accumulate over injured arterial wall cells (oxidized LDL) levels of homocysteine, inflammatory diseases, abnormal blood clotting factors, etc. C-reactive protein below 1 mg/L protein found in blood plasma, whose levels rise in response to inflammation. It is an acute-phase protein of hepatic origin that increases following interleukin-6 secretion by macrophages and T cells. (1-3) average risk >3 high risk

Key points about Lactation

Benefits of DHA: Central nervous system development Increased IQ Better vision More mature central nervous system- better sleep Supplement recommended for breast fed infants Vitamin D- started within a few days of birth (400 IU) Recommendations about smoking, caffeine and alcohol use All ok during breast feeding (avoid second hand smoke while nursing)

Nutritional Interventions for Dehydration

Beverages Contribute Nutrients + Fluid Tea has flavonoids (antioxidants) Milk has calcium, protein, riboflavin, & vitamin D Cranberry juice may reduce UTI Fruit & vegetable juices count toward fruit & vegetable servings

Maximize Accuracy

Blood Pressure- measure sitting straight Certain medications, such as over-the-counter decongestants, prescription amphetamines and the steroid prednisone, can increase blood pressure. Full bladder can raise BP 10-15 points Do not talk and remove clothing from your arm Lipid Profile- avoid strenuous exercise 12-24 hours before which can falsely raise HDL Variations can be due to: birth control pills, hormone replacement therapy, steroids and blood pressure medications such as beta-blockers and diuretics which can raise cholesterol levels

Effects of CHD

Buildup of plaque & lesion leave less room for blood flow Results may be: Decreased blood flow to heart Reduced energy Decline in organ function Inability to perform ADL Shortness of breath Chest pain

four main types of kidney stones:

Calcium-containing stones - these make up a majority, nearly 75% of stones Uric acid stones - these make up about 10% of stones Struvite (infected) stones - these make up about 10% of stones and form after an infection in the urinary tract Cystine stones - these are stones that form from the amino acid cystine, the most uncommon Animal protein makes the urine more acidic, leading to less solubility for uric acid, and suppression of citrate formation. An alkaline pH favors the crystallization of calcium- and phosphate-containing stones, whereas and acidic urine pH promotes uric acid or cystine stones

Risk Nutrients

Certain nutrients exceed or fall short of recommendations Fiber Choline Vitamin A (increase of plasma levels and liver stores 4,000) limit Calcium Vitamin D Magnesium Vitamin E Potassium Folic acid Iron 8mg and B12 inability to split from protein carriers

Three Methods of Identifying Nutrition Risk Factors

Consider total fat, saturated fat, fruits, vegetables, whole grains & caloric intake Compare adequacy of nutrient intake to the RDA or DRI Examine a population & determine how environmental factors predict nutritional health—such as the Nutrition Screening Initiative's DETERMINE checklist do you have enough money, are you physically able to get it add up score to discover if at risk two: checklist and mini nutritional assessment

US Life Expectancy Drops for the First time since 1993 (CDC, 2016

Death rate raised for the first time in 10 years (733/100,000), higher HD/stroke rates On average, the overall life expectancy, for someone born in 2015, fell from 78.9 years to 78.8 years. The life expectancy for the average American man fell two-tenths of a year — from 76.5 to 76.3. For women, it dropped one-tenth — from 81.3 to 81.2 years.

Hormonal Shifts that Affect Blood Chemistries

Decreases: Estrogen progesterone Increases: Total cholesterol LDL TG All increase more if BMI increases

Osteoporosis

Definition "Porous bone" Results from bone mass & disruption of bone architecture Prevalence Percent of men 50 years of age and over with osteoporosis of the femur neck or lumbar spine: 4% Percent of women 50 years of age and over with osteoporosis of the femur neck or lumbar spine: 16% Men more likely to be disabled and die within a year Less common in blacks since they have denser bones

Stroke: Definition & Forms

Definition "a cardiovascular disease that affects the blood vessels supplying blood to the brain" (American Heart Assoc.) Forms: Cerebral thrombosis—blood clot (thrombus) blocks blood flow to brain Cerebral embolism—wandering blood clot (embolus) lodges in artery & blocks blood flow to brain Hemorrhage—blood vessel bursts & part of brain goes w/o oxygen

Prevalence/Etiology of Cancer

Definition of cancer a group of diseases in which abnormal cellular growth affects specific organ systems Initiation & progression of cancer linked to social, cultural, genetic, & behavioral factors 4 most common cancers for adults are prostrate, breast, colorectal, & lung Prevalence- Women- BC highest, Lung 2nd Men- prostate highest, Lung 2nd Lung cancer is by far the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. Blacks—highest rate of new cancers (40% more likely to die of Breast Cancer) American Indian/Alaska natives—the lowest

Dehydration

Definition of dehydration Physiological state in which cells lose water to the point of interfering with the metabolic processes 3 types of dehydration: Isotonic, Hypotonic (loss of Na), & Hypertonic (loss of water) Etiology Typically linked to illness or other problems Diarrhea------Sweating---------Deprivation

Diabetes Mellitus

Definition: fasting blood glucose levels ≥126 mg/dL Pre diabetes fasting 100-126 mg/dL Total: 29.1 (2012) million children and adults in the United States—9.3% of the population Diagnosed: 21 million people Undiagnosed: 8.1 million people 7.6% of non-Hispanic whites 9.0% of Asian Americans 12.8% of Hispanics 13.2% of non-Hispanic blacks 15.9% of American Indians/Alaskan Natives Prediabetes: 86 million people (all 50 states have rates of ate least 6%- higher in south)

Canada's Aroma Fork

Designed to make food taste better $58.95 on Molecule-r.com. Broccoli can taste like chocolate

less than 200 mg/DL

Desirable level that puts you at lower risk for coronary heart disease. A cholesterol level of 200 mg/dL or higher raises your risk.

about mifflin-st

Developed in 1990 More accurate than Harris-Benedict Accuracy rates: Mifflin-St. Jeor 82% Harris-Benedict 69%

DSM V Criteria-2013

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Criteria is more liberal so EDNOS can be removed AN- removed the amenorrhea requirement, word "refusal" removed BN- changed to once a week for 3 months (old criteria- 2 x week/3 months) BED is associated with marked distress and occurs, on average, at least once a week over three months. (old criteria- 2 x a week/6 months)

Medical Nutrition Therapy for Diabetes

Diet flexibility and individualization ADA Exchange Lists:http://www.uaex.edu/Other_Areas/publications/PDF/FSHED-86.pdf Carbohydrate Counting Self-Monitored Blood Glucose Physical Activity in Diabetes Management Pharmacological Therapy for Type 2 diabetes Unsaturated fats, soluble fiber

Benefits of Dietary Phytoestrogens

Dietary precursors to phytoestrogens: Lignans—from whole grains, beans, peas, & flaxseed Isoflavones—from soy High-soy Asian life long diets hot flashes, however studies with Americans inconsistent (very week effect) Proposed mode of action: Phytoestrogens convert to weak estrogens

Anorexia nervosa

Distorted body image and excessive dieting that leads to severe weight loss with a pathological fear of becoming fat. Low body weight, <85% IBW, denial of seriousness Intense fear of weight gain Restricting Type Binge-Eating/Purging Type Activity Type- excessive exercise, beyond what is required for health, not interested in athletic performance

concerns about ED

Do you care more about the virtue of what you eat than the pleasure you receive from eating it? Does your diet socially isolate you? Do you spend more than 3 hours a day thinking about healthy foods? When you eat the way you're supposed to, do you feel in total control?

Considerations that Guide Supplement Choices

Does it contain a balance of vitamins & minerals? When they are combined with fortified foods, is the dose still safe? Does it contain the missing nutrients? Does it carry a USP or NF code to ensure potency & purity? Is it safe?

infancy

Down's syndrome Decreased calorie needs due to small muscle size, feeding difficulties due to weak facial muscles- may need bottle use longer, may need to delay introduction of textures and cup, high risk of being overweight Severe preterm- may need parenteral or enteral feeding- may use a gastrostomy until able to take milk by mouth- usually will need milk fortifiers due to increased nutrient needs- needs extra protein and calories, extra vitamin E

Treatment for Osteoporosis

Drug therapy include: Bisphosphonates (Fosamax, Actonel, Boniva, Reclast)- inhibit bone resorption, increases BMD Parathyroid hormone (parathormone) Calcitonin- nasal spray Raloxifene (SERM) selective estrogen receptor modulator

Disordered Eating, Dieting and Eating Disorders

ED are not always about body image. They may also be related to loneliness, stress, depression, need for control or a boost in self esteem. They also could be related to food aversions, negative food perceptions or other psychological related reasons.

Definition of Adulthood in the Life Cycle

Early adulthood—ages 20-39 yrs Midlife—ages 40 to 64 yrs 50's- sandwich generation Old age—age 65+

Hypertension: Effects and Risk Factors

Effects Extra tension on blood vessels wearing them out before natural aging process Damaged kidneys are common Risk factors alcohol consumption saturated fat intake Overweight & obesity dietary calcium

Effects of Dehydration

Effects Upper body muscle weakness Speech difficulty Confusion Dry mucous membranes in nose and mouth Longitudinal tongue furrows Dry tongue Sunken appearance of eyes in their sockets

Stroke: Effects

Effects of strokes include: Deprivation to brain of oxygen & other nutrients causing cell death Loss of speech & ability to walk & eat Quick recognition & treatment results in faster treatment & recovery

Environmental Smoke

Effects on Adults include: Triple chance of non-smoking women married to smokers to have a heart attack Increases lung cancer 34% in non-smokers Increases risk of cervical cancer Increases the chances of having a premature baby Depletion of vitamin C 1st and 2nd hand smoke lower Folic Acid levels (possibly due to depletion and alteration of FA metabolism)

Consumer trend-2016

Elimination of artificial food components Panera removed artificial ingredients from its menu (except for soda) Other companies also removing artificial ingredients (Kraft (macaroni and cheese), McDonalds, Nestle (candy bars), Snackwell), Pepsico, Mars (5 yr period)

Maintaining a Healthy Body

Energy for Weight Management Caloric expenditure declines during adulthood Due to decrease in metabolic rate & increase activity level Energy expenditure remains constant if fat-free body mass stays constant

Osteoporosis

Etiology Inadequate bone mass resulting from: decrease.. calcium intake during ages 11-17 exercise (bed rest, sedentary life-style) Increased bone loss linked to: decrease.. blood calcium that increase PTH intake of Ca, Mg, Ph, Fl, Bo, & vit D & K weight-bearing activity blood Ph increase Ca release from bones

Etiology & Effects of Cognitive Disorders

Etiology of cognitive disorders A variety of conditions cause Effects of cognitive disorders Confusion, anxiety, agitation, loss of oral muscular control, impairment of hunger or appetite regulation, changes in smell & taste, dental, chewing, & swallowing problems Nutritional interventions for cognitive disorders Hydration

RESEARCH and Vitamin D

Every tissue and cell has a VDR Obesity Flu and upper respiratory tract infections Cancer Type 1 and 2 DM Osteoarthritis MS, RA, PVD, MI Schizoprehenia, depression, dementia Infertility, preeclampsia 30 nanograms per milliliter 25-70% of Americans deficient

Diagnosing CAD

Exercise stress testing- tread mill test w/EKG may get false positive if on HRT Echocardiogram- ultrasound of the heart Cardiac arteriography (cardiac catherization)- gold standard, gives pictures of arteries, chambers, valves using a dye and x-ray

Risk Factors of CHD

Factors that have decreased since 1960 Elevated total cholesterol High blood pressure Smoking Factors that have increased since 1960 Diabetes Obesity 37% of adults have 2 or more risk factors (including inactivity and above)

Determining Energy Needs

Factors that impact needs: Gender/body size/muscle mass Activity levels Health status Hormones Individual variation BMR= 60-75%, TEF= 10%, PA= 20-40%

Fad Diets

Fad diets promote fast & easy weight loss Problems with fad diets Inadequate nutrient supply "Food combinations" Strict limitations Gimmicks

Stroke: Risk Factors

Family history African American, Asian, Hispanic Having prior stroke Long-term high blood pressure Cigarette smoking Diabetes mellitus Carotid artery disease, atrial fibrillation, transient ischemic attacks High red blood cell count Sickle cell anemia Poverty Drug abuse

Treatment/Prevention Kidney Stones-AND/American Academy of Physicians 2014

Fluids (2 L +, coffee, lemonade, citrus juice-Potassium citrate found in lemons (and other fruits and vegetables) can increase urinary citrate, which can protect against kidney stones) more common in white men over 40 if you take excessive amounts of vitamin D avoid high dose vitamin C (metabolized to oxalic acid) dietary or supplemental calcium (binds oxalate in GI tract before it reaches the kidneys) Avoid excess salt- increases urinary levels of calcium Eat smaller portions of meat (no more than 6 ounces a day). Purines found in animal-based proteins are associated with the formation of uric acid and calcium stones. Liver and other organ meats are especially rich in purines DASH diet helps prevent stone formation (high F/V) by making the urine less acidic

Food Advice Reflects Cultural Food Patterns

Food group guidance comes in many forms Canada uses a rainbow China uses a pagoda Japan's recommendations encourage enjoyment of meals: Use mealtime as an occasion for family communication Treasure family taste & home cooking

Plant Stanols and Sterols

Found in fruits, vegetables, nuts, seeds, legumes, wheat germ, veg oils Reduce LDL 5 to 15% (do not effect HDL), can use with a statin drug but not a replacement Similar in structure to cholesterol and compete for absorption in the intestine Less cholesterol and less bile is absorbed leading to body using cholesterol (taking it from circulation) to make bile Recommended intake, 2 grams per day (National Chol Education Program)- no benefit over 3 g per day Negative- can reduce absorption of Fat soluble vitamins

Comparison of Body Composition of a Young and an Old Adult

From age 20 to 70, the average man looses 24 lb of muscle & gains 22 lb of fat

AHA

Fruits and vegetables: At least 4.5 cups a day Fish (preferably oily fish): At least two 3.5-ounce servings a week Fiber-rich whole grains: At least three 1-ounce-equivalent servings a day Sodium: Less than 1,500 mg a day Sugar-sweetened beverages: No more than 450 calories (36 ounces) a week Nuts, legumes and seeds: At least 4 servings a week Processed meats: No more than 2 servings a week Saturated fat: Less than 7% of total energy intake (< 16 g if 2000 calories) Fat: 25-35%

Dietary Supplements and Heart Disease

Garlic- WHO recommends 1 clove per day 2013, raw garlic 2 x week reduced lung cancer risk 44% in Chinese study (6000 subjects) Due to diallyl sulphide (breakdown product of allicin) Green tea Red yeast (Monascus) Coenzyme Q10 or ubiquinone

The Promise of Prevention: Health Promotion

Good nutrition habits make a greater impact when started early in life Many people are not motivated to make changes until later in life or when health problems occur The belief that an 80 y/o is too old to learn and practice health promotion strategies is an outdated myth

Tea and Kidney stones

Green tea found to decrease risk (possibly due to antioxidants or change in shape of crystal) Green and herbal teas have lower levels of oxalate Black tea associated with higher risk

Heart Disease

HD is characterized by atherosclerosis, or hardening of arteries, due to plaque buildup Arteries narrow increasing risk of: Myocardial infarction shut off blood in heart (AKA heart attack) Strokeblood shut off to cerebral artery of the brain 1/3 of Americans have elevated LDL, 2/3's HTN

Added Sugars

HFC (55% fructose/45% glucose), table sugar (50% fructose/50% glucose) Fructose may raise TG more than glucose, may also contribute to visceral fat, may raise risk of gout (fructose raises uric acid levels- which also inhibits Nitric Oxide and impairs glucose uptake)

Common Botanicals and Nutraceuticals

Herbs and spices (Rosemary, sage, thyme, cinnamon, clove, & ginger) Protect against oxidative stress Caffeine and guarana Stimulant—older people become more sensitive Black & green teas Phytochemicals like catechins & flavonols that are antioxidants Garlic Allicin (antibacterial) Ajoene (blood thinner)

HDL 60 mg/dL and above

High HDL cholesterol. An HDL of 60 mg/dL and above is considered protective against heart disease.

240 mg/dL and above

High blood cholesterol. A person with this level has more than twice the risk of coronary heart disease as someone whose cholesterol is below 200 mg/dL.

Prevalence of Dementia

In the U.S. 14% of older adults (>70) have dementia ~10% have Alzheimer's disease (AD) Prevalence with age AD ranks 6th in leading cause of death for adults >65 years (5.4 million Americans have AD)

Protein

Inactive, older adults living alone may have low protein intakes Several researchers report protein needs for older adults are 1 to 1.3 g/kg body wt (higher than the DRI of 0.8 g) risk of stroke went down 26% for every increase of 20 grams of protein in the daily diet. (Neurology, 6/2014) Higher protein intakes (about 100 g/day) associated with lower BP (Am J HTN, 9/2014) (due to nitric oxide and sodium regulation) Nitrogen balance is easier to achieve when: Protein is a high quality Adequate calories are consumed Elders participate in resistance training

Sarcopenia Obesity

Increased body fat and decreased muscle mass and quality Associated with deteriorations in physical disability, morbidity, and mortality Risk factors: excessive energy intake, physical inactivity, low-grade inflammation, insulin resistance and changes in hormones Together- higher risk of metabolic syndrome than sarcopenia or obesity alone

Energy for Weight Change (old method)

Initially~3500 kcal needed to lose (or gain) 1 lb (1958 rule for weight loss) Either +/- 500 kcal/day to gain or lose 1 lb a week (short term) When losing weight- over time 3500 cal/lb will become an over estimate due to physiological changes that result in a lower BMR Two new weight loss calculators provide conservative estimates of weight loss

Age-associated Changes in Metabolism: Nutrients of Concern

Iron Iron needs after menopause (8 mg) Most older adults consume more iron than needed Most 50+ MVIs do not contain iron Excess iron contributes to oxidative stress Reasons that some older adults may have iron deficiency include Iron loss from disease or medications acid secretion calorie intake

Childhood

Iron deficiency anemia Risk factors are: cow's milk given before 12 months, drinking more than 24 oz per day of cows milk, poor diet, low income, chronic illness Nutritional Intervention: iron fortified foods (cereals, meat, vitamin C) multivitamin with iron Cystic Fibrosis (treatments) 1.Increased calorie/protein needs 2-4 times above normal 2. digestive enzyme supplements 3. fat soluble vitamin supplements or multivitamin Disease causes excess mucus production which blocks pancreas and fills lungs making it hard to breath ADHD (attention deficit hyperactivity disorder) Nutritional interventions: avoid TV at meal times, avoid preservatives and artificial food dyes, time meals when medications are at low peaks since meds decrease appetite. Try magnesium, omega 3 and zinc supplements. PKU (genetic disorder) Avoid protein foods and nutrasweet (aspartame) use PKU supplements, low protein food supplements/products

Why a Gender Difference?

It is not completely clear why the difference, but the following may explain the difference: Size and pumping ability of right side of heart differs between men and women blood vessel walls of the very small arteries that branch out from the coronary arteries are more likely to be damaged in women as compared to men. Researchers are still learning about the role hormones play in women's heart health.

Other Dietary Supplements

Kava Muscle relaxant & anticonvulsant Found effective for menopausal symptoms Side effect liver toxicity

Pregnancy

LBW Causes- adolescent pregnancies, lack of prenatal care, poor weight gain, low income, normal weight woman should gain 25-35 lbs. Pre-eclampsia Risk factors- low physical activity, obesity, diabetes, insulin resistance, smoking, age over 35, inadequate antioxidants, high trans fats in the diet Treatment- PA and vitamin D Fetal Alcohol Syndrome No safe level of alcohol Causes behavioral problems, aggression, short attention span, stunted growth, birth defects. Nausea (morning sickness) Ginger, B6, small frequent meals

Physical Activity Recommendations

Lack of physical activity is associated with higher risk of death or disability At least 30 minutes/day of physical activity Resistance training at least 2 times a week More than 80 percent of adults do not meet the guidelines for both aerobic and muscle-strengthening activities Less than one-quarter of adults over 45 meet the muscle-strengthening recommendations set by the Department of Health and Human Services

Considerations for Educational Materials for Older Adults

Larger type size Serif lettering (such as Times Roman) Bold Type High contrasts (black on white) Non-glossy paper Avoid blue, green & violent Reading level of 5th to 8th grade

Physiological Changes

Lean body mass (LBM) Sum of fat-free tissues, mineral as bone, & water

What to Do

Learn about Eating Disorders Talk in a non-threatening manner IMAD approach Inefficiency Misery Alienation Disturbance Emphasize concern for them and their health

Life Expectancy and Life Span

Life expectancy (78.8) (81/76) Average number of years of life remaining for persons in a population cohort or group; most commonly reported as life expectancy from birth http://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf (changes in life expectancy M/F, W/B) Life span Maximum number of years someone might live; human life span is projected to range from 110 to 120 years

Warning signs of an ED

Loose fitting clothes, many layers, winter coat indoors Role models are thin celebrities Lies about food, hides food/dishes, often says they already ate Excuses self after meals, anxiety over eating Cutting food up into small bites, pushing it around plate, hiding food under napkins Social isolation Reading cookbooks/food magazines/websites, cooking foods but not eating them Excessive gum chewing or diet soda/water consumption

HDL Less than 40 mg/dL (for men) Less than 50 mg/dL (for women)

Low HDL cholesterol. A major risk factor for heart disease.

New AHA guidelines released 11/12/13

MI/stroke risk equations (AA have separate equation) for 10 year and lifetime risk Target cholesterol numbers only refer to those with very high levels Statin Drug therapy recommendations New dietary and exercise recommendations 40 minutes moderate intensity activity 3-4 x a week Diet pattern emphasized (occasional indulgences ok)

Etiology of Eating Disorders

Main groups of contributing factors for eating disorders psycho-developmental factors: bodily changes, life transitions socioculture factors: peers, media, lifestyle, family values neurochemical or genetic factors: brain chemistries, dna, personality structure 50-80% of the risk for anorexia and bulimia is genetic.

Actual Energy Intake Using Food Disappearance Data

Main source of calories ages 2+ grain based desserts, followed by bread for adults and young children 2014 USDA survey- average American is consuming 118 fewer calories per day compared to 10 years ago

WHO- 3/2015 Sugar Recommendations

Maximum of 10% of total calories Aim for no more than 5% of total calories Added sugars includes fruit juice 2000 calorie diet (100 calories max or 6 oz of juice a day) In the U.S., adults get about 11 to 15 percent of their calories from sugar; children about 16 percent. In Europe, sugar intakes range from about 7 percent in Hungary and Norway to 17 percent in Britain to nearly 25 percent in Portugal.

When to Consider Supplements

May be useful with those who: Lack appetite resulting from illness, loss of taste or smell, or depression Have diseases in GI tract Have a poor diet due to food insecurity, loss of function, or disinterest Avoid specific food groups Take medication or other substances that affect absorption or metabolism

Hypertension- new AMA guidelines (12/2013)

Medication prescribed for those over 60 when: BP exceeds 150/90 Under 60: Kidney disease and BP exceeds 140/90 Diabetes and BP exceeds 140/90 AHA recommends if blood pressure is between 140/90 and 159/99 should be treated with lifestyle changes, 160/100 or higher treated with medication and lifestyle changes

MIND Diet

Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet - was created by nutritional epidemiologist Martha Clare Morris, PhD, and colleagues at Rush. It consists of 15 dietary components: 10 "brain-healthy food groups" and five unhealthy food groups. Green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and wine make up the brain-healthy foods, while red meats, butter and stick margarine, cheese, pastries and sweets, and fried or fast food are the food groups that should be limited Moderate adherence to MIND diet reduced Alzheimer's risk by 35%

Other Types of ED

Megarexia, or bigorexia, is the obsession with one's own musculature. Reverse Anorexia Obsessed with body, protein intake, takes over life Fad Bulimia- occasional Orthorexia Night Eating Syndrome 1-2 % of adults, 25% of obese

Symptoms of a Heart Attack

Men Chest pain Left arm pain Right jaw pain Sweating Nausea Women Chest, arm, back pain Fatigue Sleep Disturbance SOB Nausea/indigestion Dizziness Anxiety Edema (ankles/legs) Fluttering Sweating

Glucophage and Statins

Metaformin (Glucophage & Glumtza) Acts by increasing insulin sensitivity of liver, muscle, adipose, & other tissues Statins (Lipitor, Lescol, & Crestor) Slow or block the HMG-CoA—main enzyme in cholesterol synthesis by the liver

The Mifflin-St. Jeor Estimation Formula

Mifflin-St. Jeor Formula males: RMR = (10 x wt) + (6.25 x ht) - (5 x age) + 5 females: RMR = (10 x wt) + (6.25 x ht) - (5 x age) - 161

A Picture of the Aging Population: Vital Statistics

More Americans are living longer Currently, ~46.2 million >65 yrs By 2060, ~98 million will be >65 yrs Persons ≥85 are the fastest growing population group

Treatment

Multidisciplinary Varies based on symptoms and severity Focus on understanding that quality of food is not the only determinant of health Cognitive behavioral therapy Patients tend to respond well to treatment because of their concerns with health and self-care Focus on nutrition education, all foods can fit Food is many things (nourishment, culture, tradition, holidays, enery)

Nutrition Interventions

National Cholesterol Education Program Total fat intake from 25-35% of calories Sat. <7% calories (2010 DG) Mono up to 20% calories Poly <10% calories CHO from 50-60% calories Dietary fiber 20-30 g/day (10-25 g soluble) Plant stanols or sterols: 2 g/day Weight reduction for obese ≥200 cal/day spent for physical activity

Treatment

Need to change irrational thinking Focus on food as nourishment vs as a tool to control or punish Promote positive self esteem Retraining body to recognize hunger and fullness Avoid trigger foods, obsessive behaviors Break the chain or cycle exercises Avoid "don't eat" messages

Consequences of Smoking

Nicotine decreases the strength of hunger contractions of the stomach, increases blood sugar levels, and deadens taste buds When a smoker tries to quit, food becomes more appealing due to the increased sense of taste and smell Wrinkles Bone loss Stained teeth Infertility SIDS Early onset of menopause

Freeze Dried F/V

No loss of nutrients No added sugars Purchase 100% fruit varieties

Nutrient Recommendations

Nutrient recommendations change as scientists learn more about effects of foods on human functions Specific DRI for those >51 yrs were 1st established in 1997, calcium 1200 mg (Females 51+) Males 71+ Vitamin D (600 IU) up to age 70, (800 IU) 71+ Estimating Energy Needs Decrease in physical activity & BMR from early to late adulthood results in ~20% fewer calories needed

Community Food and Nutrition Programs

Nutrition Programs Serving Older Adults— USDA's Supplemental Nutrition Assistance Program (SNAP) Seniors' Farmers Market Nutrition Programs Commodity Supplemental Foods Child and Adult Care Food Program Meals on Wheels Grocery programs

Risk Factors of Cancer

Nutrition-related risks Obesity & insulin resistance increase alcohol consumption decrease intakes of fruits, vegetables, & calcium Diet/food related risks increase fat Charred foods (grilled meats) processed meats Helicobacter pylori Nutrition Intervention Smoking- 30% of cancers

Physiological Changes of Adulthood

Nutritional emphasis: maintaining physical status (muscle strength) muscle mass peaks 25-30 Bone density- maintain peak bone mass avoiding excess fat (especially around the midriff) Fat redistribution- gains in the central & intra-abdominal space, decrease in subcutaneous fat 2014 British study- going up a skirt size every 10 years (ages 25-60) raised chances of breast cancer by 33 percent, (77% if 2 sizes every 10 years)

Stroke: Prevalence & Etiology

Of adults ≥65, 8% of females & 9% of males have had a stroke 1 out of 20 deaths Etiology Blocked arteries Easily clotting blood cells Weak heartbeat unable to circulate blood

Osteoporosis

Of older people who break a hip: 10-20% die within a year 50% have permanent disabilities Shrinking height, kyphosis ~67% of vertebral fractures are asymptomatic Results from compression and/or bone fracture in spine

Food Safety

Older adults are vulnerable to foodborne illness because they have compromised immune systems Leading hazardous practices: Improper holding temperatures Poor personal hygiene Contaminated food preparation equipment Inadequate cooking time

Changing Sensual Awareness: Oral Health—Chew and Swallow

Oral health depends on: GI secretions (saliva) Skeletal systems (teeth & jaw) Mucus membrane Muscles (tongue & jaw) Taste buds Olfactory nerves (smell & taste) Healthy People 2020 Objective: Reduce % of people aged 65-74 who have lost all their teeth from 24% to 21.6%

The Source of Physiologically Active Compounds

Over 4,800 chemical compounds are found in tobacco smoke, 60+ carcinogenic Nicotine Addictive stimulant Acts upon the dopamine neurotransmitter in the brain to cause excitement Causes serious effects upon the cardiovascular system tar (phenol, cresol, benzopyrene, DDT) Accumulates in the alveoli (sacs in the lung tissue) and inhibits lung function Disables the function of cilia

heart attack

Oxidized LDL cholesterol creates an "injury" by burrowing into the artery wall. 2. The immune system sends inflammatory cells like monocytes to heal the injury. 3. Monocytes enter the wall and turn into macrophages, which gobble up the LDL cholesterol. 4. The LDL-stuffed macrophages form a "fatty streak." 5. Over decades, more cholesterol, connective tissue, calcium, and cell debris accumulate, turning the streak into plaque. Smooth muscle cells form a fibrous cap over the plaque. 6. Macrophages break down the cap. 7. The cap ruptures. When a clot forms around the rupture, blood flow is blocked, which triggers a heart attack or stroke.

PANERA first to post added sugars

Panera has reformulated two of its proprietary drinks, Passion Papaya Green Tea and Agave Lemonade, reducing their sugar content by roughly 40 percent. Passion Papaya now contains 30 grams of added sugar in a 20-ounce serving without ice, while the same size serving of Agave Lemonade contains 34 grams of added sugar.

Common Botanicals and Nutraceuticals

Phytochemicals Plant based (resveratrol, flavonoids, carotenoids, indoles, isoflavones, lignans, & salicylates) Reduce chronic disease (cataracts) Pre- and probiotics Reestablish intestinal bacteria

Obesity Treatment

Programs that use cognitive behavioral therapy/mindful eating, most effective Programs are 12 to 16 weeks long to: Build knowledge Modify beliefs and attitudes Integrate new behaviors Recognize and replace automatic and irrational thoughts and beliefs (Cognitive restructuring) Increase awareness and control of cues associated with eating (Stimulus control) Just providing nutrient and exercise guidelines is not effective Realistic goals Caloric deficit Stress management Support system Regular exercise Maintenance

Bulimia nervosa

Recurrent episodes of binge eating (once a week for 3 months) Lack of control over eating Recurrent inappropriate compensatory behavior Self-evaluation based on weight Purging and non purging (fasting/exercise) types

Binge eating disorder

Recurrent episodes of binge eating associated with guilt, lack of control over eating (once a week for 3 months) Eating more rapidly than normal, until very full, eating alone due to embarrassment, eating large amounts of food without hunger, feeling disgusted with oneself, depressed, guilty over eating Experiencing marked distress regarding binge eating

Nutritional Risk Factors 60% of adults >65 at risk for/have malnutrition

Risk factors for older adults are: Hunger, poverty, low food & nutrient intake Functional disability Social isolation or living alone Urban & rural demographic areas Depression, dementia, dependency Poor dentition & oral health Diet-related acute or chronic diseases Polypharmacy Minority, advanced age

Effects of Diabetes

Short Term Blurred vision urination weight infections decrease wound healing Hunger & thirst Long Term Heart disease Hypertension Stroke Poor circulation Blindness Kidney failure Loss of limbs

Orthorexia

Similarities with other eating disorders Need for control May lead to malnutrition and weight loss Often share common history with anorexic patients- detailed, careful, tidy, etc. Different from AN and BN in that the obsession is with quality and purity rather than quantity and does not stem from a desire for weight loss or poor body image. Similarities with obsessive-compulsive disorders include perfectionism, control, and phobic and hypochondriac mechanisms.

To use or not? Potential Drawbacks of Increasing Dietary Phytoestrogens

Soy has estrogenic effects Soy increases the risk for breast cancer in test tubes and rodents, not in case control studies Taste of soy is unappealing/GI side effects Flax in large amounts (>1.5 oz) acts as a laxative Soy is not a "magic pill" but it can improve diet quality.

New AHA guidelines released 11/12/13

Statin Therapy recommended to: People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years. People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization. People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher). People with Type 1 or Type 2 diabetes who are 40 to 75 years old.

2015 DG

Sugar- max of 10% of total calories Sodium limits 2300 mg for 14+, lower amounts for younger Cholesterol limits removed 8 oz of fish per week to get 250 mg EPA/DHA Emphasis on healthy eating pattern Moderate coffee consumption Whole grains, fruits, vegetables, dairy products Vitamin D and Choline, nutrients of concern

dementia symptoms

Symptoms- presence of excessive amounts of amyloid plaques and tangled nerves called neurofibrils, level of the neurotransmitter acetylcholine is diminished which impairs memory, free radicals may also damage neurons leading to cell death

Changing Sensual Awareness: Taste and Smell

Taste & smell senses decline with age Decline in ability to identify smells varies by gender In men, decline begins ~age 55 In women, decline is >age 60 Disease & medications affect taste & smell more than aging

Sarcopenia

Term used for loss of LBM and strength associated with aging and increased risk of physical disability, poor quality of life and mortality Diagnosed with low muscle mass plus low muscle strength (hand grip strength)or low physical performance (up and go test or gait speed)

Sept 2014- Soda companies make cuts

The Coca-Cola Company, PepsiCo Americas Beverages, and the Dr Pepper Snapple Group all pledged to help fight the obesity crisis by steering consumers away from sugary drinks loaded with empty calories. Small can size, marketing lower calorie options, coupons Goal- reduce beverage calories by 20% by 2025

Cholesterol

The HMG-CoA Reductase reaction is rate-limiting for cholesterol synthesis. This enzyme is highly regulated and the target of statin drugs

Mini-Nutritional Assessment

The MNA combines 6 screening questions in stage 1 with 12 assessment questions in stage 2 More extensive than the NSI & includes: Mid-arm & calf circumferences Questions related to lifestyle Medications Dietary intake Anthropometrics

What is a Desirable Weight?

The Miller Method (an easy-to-remember method) Female: 119 lbs for 1st 60" + 3 lbs for each additional inch Male: 135 lbs for the 1st 63" + 3 lbs for each additional inch

Stroke: Nutritional Remedies

The overall goal is to normalize blood pressure Other goals include: Reduce overweight & obesity—mainly abdominal fat Moderate alcohol intake

Risks of Tobacco Use

Tobacco is a vasoconstrictor,(constricts coronary arteries) Tobacco causes releases of catecholamines which constrict blood vessels leading to hypertension CO in smoke lowers oxygen levels in blood, increases risk of an MI, also thickens blood The use of oral contraceptives and smoking cigarettes increases the risk 4 times for a woman to have a heart attack vs. only smoking Risk of CAD is reversed after a year of quitting

2020 Objectives

Total Cholesterol- average 198 mg/dl Target 10% improvement to 178 mg/dl 15% of adults have high cholesterol (>240) Target 10% improvement to 13.5% 30% of adults have high blood pressure Target 10% improvement to 27%

Sugar Shock

Typical American consumes 475 calories (30 tsp) a day in added sugars (46%-beverages) Increased risk of DM, HD (HDL,TRIG, BP), obesity, gout 500% increase in soft drink consumption past 50 years (liquid sugar intake not associated with caloric compensation- weak satiety signals)

Age-associated Changes in Metabolism: Nutrients of Concern

Vitamin A Plasma levels & liver stores increase with age May be linked to decrease clearance from the blood Older adults more vulnerable to toxicity & possible liver damage than deficiency Beta-carotene will not damage the liver 4000 IU limit to prevent toxicity/hip fracture

Age-associated Changes in Metabolism: Nutrients of Concern

Vitamin B12 Despite adequate intake, ~40% of older adults have decrease serum B12 levels decrease B12 linked to decrease levels of HCL & pepsin (from atrophic gastritis) in aged persons resulting in inability to split B12 from protein carriers Synthetic or purified B12 is not protein bound and is much better absorbed

Age-associated Changes in Metabolism: Nutrients of Concern

Vitamin D, Calciferol Factors that put older adults at risk for deficiency: 1. Limited exposure to sunlight 2. Institutionalization or homebound 3. Certain medications (barbiturates, cholestyramine, Dilantin, laxatives)

Getting Help

What to do Encourage to get help Go with them What not to do Comment on food or weight Blame, criticize

hypertension prevalence increase with age

african american women - 45.7

Prader wili syndrome

almond shaped eyes picking at skin hitting object or yourself occurs in hypothalamus lock all food, calories controlled diet calm environment

bulimia affects your body

blood: anemia heart: irregular heart beat body fluids: dehydration, irregular bowel intestines: constipation brain: depression cheeks: swelling soreness

200 to 239 mg/dL

borderline high

anorexia affects your whole body

brain and nerves: cant think right hair: hair things and gets brittle heart: low blood pressure, slow heart rate blood: anemia muscles: weak muscles, swollen joints kidney: kidney stones body fluids: low potassium intestines: constipations, bloating hormones: periods stops, bone loss skin: bruise easily

DG Recommended Macronutrient Proportions by age

carbohydrate Protein fat Young children (1-3 years) 45-65% 5-20% 30-40% Older children and adolescents 45-65% 10-30% 25-35% Adults (19 years and older) 45-65% 10-35% 20-35%

osteoarthritis

cartilage becomes thin and damaged inflammation results in the development of bony ridged and spurs cartilage further damaged as bones rub together deformity of th e joint loss of movement

Hemoglobin A1C

glycosylated hemoglobin- excess glucose binds with hemoglobin 2-3 month average blood glucose Life span of a red blood cell (120 days) Normal= 5%, goal <7% (6.5= DM) Very high= 25% Measure 2 x a year Used in addition to daily monitoring A1C 7% Preprandial plasma glucose (before a meal) 70-130 mg/dl Postprandial plasma glucose (after a meal)* <180 mg/dl

triglyceride level

less than 100 optimal less than 150 normal

LDL

low density lipoproteins bad cholesterol

Food Matters: Nutrition Contributes to a Long and Healthy Life

main concern: maintain muscle mass avg. american 78 years old Cumulative effects of lifelong dietary habits determine nutritional status in old age CDC suggest that longevity depends on: 10% access to health care 19% genetics 20% environment (pollution, etc.) 51% lifestyle factors (besides not smoking, a healthy diet & ample exercise contribute most to longevity)

calcium lost in urine

salt 26mg protein 1 mg - 7 mg caffeine 40

three types of strokes

thrombotic 90% embolic 90% hemorrhage 10%

Cholesterol

waxy fat carried trhough the bloodstream by lipoproteins

Prognosis for People with Bulimia Nervosa

~4% die from disease Deaths related to heart failure resulting from electrolyte abnormality or suicide Recovery rates ~48% full recovery ~26% improvement ~26% chronicity