NUSC 2200 - Final

What is the definition of osteoporosis? What is the prevalence?

"Porous bone," results from decreased bone mass/disruption of bone architecture. Prevalence: - Men 50/older - 4% - Women 50/older - 16%

Relate the percent of water loss with the physiological signs

- 1% - thirst - 4-6% - economy of movement, fatigue, etc. - 8% - dizziness, slurred speech, weakness, confusion - 12% - wakefullness, delirium - 20% - bare survival limit

What are the effects of hypertension?

- Extra tension on blood vessels wearing them out before natural aging process - Damaged kidneys common

What are the major risk factors for stroke? What are other risk factors?

- Family history - African American, Asian, Hispanic - Prior stroke - Long-term HBP - Cigarettes - Diabetes - Caratoid artery disease, atrial fibrillation, TIA - High RBC count - Sickle cell - Poverty - Drug abuse

What are the diet/food related risks for cancer?

- High fat - Charred foods (grilled meats) - Processed meats - Helicobacter pylori

What are the causes of kidney stones?

- Low fluid intake, low calcium intake, excess body weight, diabetes, foods high in oxalate

What are some of the diet components that contribute to loss of calcium from the urine?

- Salt - Protein

What are some of the organs affected by estrogen loss in postmenopausal women?

- Urinary tract/vagina - Heart - Bones

What are the different type of teas for botanicals that can be prepared? Which one has the highest concentrations of antioxidants? Which ones have the lowest?

- White tea (400-600mg) - Jasmine - Green - Black - Rooibos (60-80mg)

What are the proteins recommendations for older adults? Why do you think they are higher?

1 to 1.3 g/kg body wt. - Higher protein intakes associated with lower BP

What are the three theories of aging?

1. Programmed aging 2. Wear and tear theories 3. Calories restriction and longevity

What is the definition of adult in terms of age?

Anyone over 20 - Early adult: 20-39 - Midlife: 40-64 - Old age - 65+

What are the reasons that appetite and thirst weaken with age?

Appetite - hunger and satiety cues weaken, more cautious. Thirst - thirst-regulation decrease w/ age, dehydration occurs more quickly, rehydration is less effective

What is the prevalence of dementia? Alzheimer's?

Dementia: 14% Alzheimers ~10%

What hormones decrease in menopause?

Estrogen Progesterone

Why are food safety recommendations important for older adults?

More vulnerable to food borne illness because they have compromised immune systems.

What are the guidelines to prescribe medication for hypertension for those over 60? Under 60?

Over 60: - BP exceeds 150/90 Under 60: - Kidney disease and BP exceeds 140/90 - Diabetes " " "

Which is the fastest growing population

People over 85

What are amyloid plaques?

Sticky buildups the accumulate on the ends of nerve cells, or neurons...toxic to neurons in the brain.

Which university has MyPlate for the 70+ adults?

Tufts

What is a mini-stroke?

When a cerebral artery is temporarily blocked, decreasing blood flow to brain

How does a clot formation in an artery lead to a heart attack?

When a clot forms around the ruptured cap, blood flow is blocked, triggering a heart attack.

What are the recommended proportions of carbohydrate, fat, and protein for different ages?

Young children: - Carbs: 45-65% - Protein: 5-20% - Fat: 30-40% Older children/adolescents: - C: 45-65% - P: 10-30% - F: 25-35% Adults: - C: 45%-65% - P: 10%-35% - F: 20-35%

What are the blood sugar levels that define diabetes?

equal to or greater than 126 mg/dL

According to CDC, what does longevity depend on for adults over 65?

- 10% access to health care - 19% genetics - 20% environment - 51% lifestyle factors

What is the outcome of people who break a hip due to osteoporosis?

- 10% die within a year - 50% have permanent disability

How many people are diagnosed with diabetes? How many undiagnosed? What is the ethnic group who have the highest number of undiagnosed diabetes? Lowest?

- 29.1 million total (9.3%) - 21 million people diagnosed - Undiagnosed: 8.1 million people - 15.9% of American Indians/Alaskan Natives undiagnosed - 7.6% of non-Hispanic whites undiagnosed

Racial group w/ more hypertension? Less? Role of age in hypertension?

- African Americans have more hypertension - Mexican Americans have less - Older you get more hypertension

Do dietary phytoestrogens work well for Asian females? What about American females?

- Asians: Yes, high-soy life long diets decrease hot flashes - Americans: inconsistent, weak

What are the physical activity recommendations for adults? Muscle strengthening?

- At least 30 mins/day physical activity...resistance training at least twice a week Muscle strengthening: 2 days/week

What is the etiology of a stroke?

- Blocked arteries - Easily clotting blood cells - Weak heartbeat - Unable to circulate blood

Describe the symptoms of osteoarthritis

- Cartilage thin and damaged - Inflammation causes bony ridges/spurs - Cartilage damaged as bones rub together - Deformity of the coin results as one side collapses - Loss of movement, pain, stiffness, swelling

What are some common botanicals that older adults take?

- Centrum - One a day - Nature made

How is food advice provided by other countries? For example: China, Canada, Italy, Japan, UK, Australia?

- China uses pagoda - Canada uses a rainbow - Japan recommends enjoyment of meals (family time) - Italy and Australia use a pyramid - UK uses the eatwell plate

What is the etiology of cognitive disorders for AD? What is important to do nutrition wise?

- Confusion, anxiety, agitation, loss of oral control, impairment of hunger or appetite regulation, changes in smell and taste, dental, chewing/swallowing Nutritional - drink a lot of water

What are the stroke effects?

- Deprivation to brain of oxygen and other nutrients causing cell death - Loss of speech and ability to walk and eat

List some of the metabolic pathways affected by nitric oxide

- Dilates blood vessels - Reduce platelet stickiness - Reduces oxidation of LDL

What are warning signs for poor health in the older adults?

- Disease: makes hard to eat - Eating poorly - Tooth loss/mouth pain - Economic hardship - Reduced social contact - Multiple medicines - Involuntary weight loss/gain - Needs assistance in health care - Elder years above 80

How can coronary artery disease be diagnosed? What is the gold standard?

- Exercise stress testing - treadmill test with EKG - Echocardiogram - ultrasound of the heart - Cardiac arteriography - gold standard (gives pictures of arteries, chambers, valves, using a dye and x-ray)

Etiology of hypertension

- Family history - African Americans - ~20% of cases linked to salt intake

What can prevent kidney stone formation? What nutrient can cause kidney stones?

- Fluids (coffee, lemonade, citrus, fruits/veggies) can protect against kidney stones. - Avoid high dose vitamin C

What does oral health depend on?

- GI secretions (saliva) - Skeletal systems (teeth/jaw) - Mucus membrane - Muscles (tongue/jaw) - Taste buds - Olfactory nerves (smell/taste)

What are some of the dietary supplements used for heart disease?

- Garlic (1 clove/day) - Green tea - Red yeast - Coenzyme Q10 or ubiquinone

What are the main factors by which older adults can be malnourished? Make sure you know them all.

- Hunger, poverty, low food/nutrient intake - Functional disability - Social isolation/living alone - Urban/rural demographic - Depression, dementia, dependency - Poor dentition/oral health - Diet-related acute/chronic disease - Polypharmacy - Minority, advanced age

What are the risk factors of hypertension?

- Increased alcohol consumption - Increased saturated fat intake - Overweight and obesity - Decreased dietary calcium

When should supplements be considered for the older adult?

- Lack of appetite resulting from illness, loss of taste/smell, depression -Diseases in GI tract - Poor diet due to food insecurity, loss of function, disinterest - Avoid specific food groups - Take medicine/substance that affect absorption/metabolism

What are some of the considerations to be aware of when preparing educational materials for the older adults?

- Larger type size - Serif lettering - Bold type - High contrast - Non-glossy paper - Avoid blue, green, violet - Reading level of 5th to 8th grade

What is the etiology of osteoporosis?

- Low calcium intake ages 11-17 - Low exercise - Low block calcium that high PTH - Low intake of Ca, Mg, P, F, vit D & K - Low weight bearing activity - Low blood P, high Ca release from bones

Have any of the objectives for healthy people 2010 been met? Which ones got worse?

- Met dietary recommendations for calcium Gotten worse: - Increase number at healthy weight - Decrease the number of obese - Eat no more than 30% of calories from fat - Increase doctors visits by patients with CV diseases, diabetes, etc.

What are the most used medications to treat diabetes? What is an insulin pump?

- Metaformin - Statins Insulin pump: dosage instructions entered into the pump and appropriate amount of insulin is injected into the body in a controlled manner.

What is the relationship between ethnicity and no natural teeth? Which race does better and which does worse? What about socioeconomic status?

- Mexicans do well (only 15.7%) - White (21.9%) - Blacks (32.0%) - Poor (36.8%) - Not poor (16.1%)

Consequences of smoking

- Nicotine decreases strength of hunger contractions of stomach, increase blood sugar levels, deadens tastebuds. - Wrinkles - Bone loss - Stained teeth - Infertility - SIDS - Early onset menopause

How is CAD treated when it is not life threatening? What is used in surgery when it is life threatening?

- Non life-threatening: drugs, diet Surgery: - Angioplasty - narrowed arteries are dilated with a balloon so blood can flow more easily. - Stents - short mesh tubes made of wire used to prop open coronary arteries after angioplasty. - CABG - veins or arteries are used to bypass clogged or blocked arteries...improves blood supply to the heart

What are the nutrition-related risks of cancer?

- Obesity/insulin resistance - High alcohol consumption - Low intake of fruits, vegetables, calcium

What are the situations when statins are recommended?

- People w/o CVD 40-75 years old and have 7.5% or higher risk for heart attack/stroke within 10 years - People with history of heart attack, stroke, etc. - People 21 and older with high levels of LDL - People with Type 1 or Type 2 diabetes

What are some of the problems with Vitamin A in older adults?

- Plasma levels and liver stores increase with age - May be linked to decrease clearance from blood - More vulnerable to toxicity and possible liver damage

What are the 4 most common cancers for adults? The highest in women? The highest in men?

- Prostate (men) - Breast (women) - Colorectal - Lung

What 3 important things need to happen to ensure that nitrogen balance is achieved?

- Protein is a high quality - Adequate calories are consumed - Elders participate in resistance training

Mention some of the guidelines in addition to diet and exercise for obesity treatment

- Realistic goals - Caloric deficit - Stress management - Support system

What are soda companies doing to help in the restriction of sugar?

- Small can sizes, market lower calorie options, coupons

What is the opinion of the American Heart Association on sugar-sweetened beverages, processed meats and saturated fat?

- Sugar-sweetened drinks: no more than 450 calories a week - Processed meats: no more than 2 servings/week - Saturated fat: less than 7% of total energy intake

How dangerous is environmental smoke?

- Triple chance of non-smoking women married to smokers to have a heart attack - Increases lung cancer 34% in non-smokers - Increased risk of cervical cancer - Increased risk of premature birth - Depletion of certain vitamins

What are the recommendations of Vitamin D for adult men? Adult women? Populations at risk?

-Adults: 800-2,000 IU/day -Pregnant women: 1,500-2,000 IU/day - Premature infants: 400-800 IU/day - Obese children: 1,200-2,000 IU/day - Obese adults: 1,600-4,000 IU/day - Night workers: 1,000-2,000 IU/day

What are the four main types of kidney stones?

1. Calcium-containing stones 2. Uric acid stones 3. Struvite (infected) stones 4. Cysteine stones

Three forms of stroke

1. Cerebral thrombosis: blood clot, blocks blood flow to brain 2. Cerebral embolism: wandering blood clot lodges in artery and blocks blood flow to brain 3. Hemorrhage: blood vessel bursts and part of brain goes without oxygen

What are the considerations that need to be taken in the choice of supplements by the older adults?

1. Does it contain a balance of vitamins and minerals? 2. When they are combined with fortified foods, is the dose still safe? 3. Does it contain the missing nutrients? 4. Does it carry a USP or NF code to ensure potency and purity? 5. Is it safe?

What are the three types of dehydration?

1. Isotonic 2. Hypotonic (loss of Na) 3. Hypertonic (loss of water)

What are the effects of dehydration? How long does a person take to die of dehydration?

1. Upper body muscle weakness 2. Speech difficulty 3. Confusion 4. Dry mucous membranes in nose/mouth 5. Longitudinal tongue furrows 6. Dry tongue 7. Sunken appearance of eyes in sockets Takes 10 days to die

According to AHA, what is prevalence of hypertension?

1/3 adults

What are the characteristics of good programs for obesity treatment?

12-16 weeks long: - Build knowledge - Modify beliefs/attitudes - Integrate new behaviors - Recognize and replace automatic and irrational though and beliefs - Increase awareness and control of cues associated with eating

What are the calcium requirements for those 51+?

1200 mg

What are the recommendations for water?

1mL/kcal consumed

How much sugar is there in a soda? A strawberry yogurt? Frozen coffee?

20 oz soda - 16 tsp 6 oz yogurt - 3 tsp Coffee - 5 tsp

What are the four leading causes of death in 20-24 year old adults? 25-44? And 45-65?

20-24: - Accidents - Homicide - Suicide - Cancer 25-44: - Accidents - Cancer - Heart disease - Suicide 45-65: - Cancer - Heart disease - Accidents - Chronic Respiratory Disease

At what age does muscle mass peak?

25-30

How many Americans have AD? And what is the rank of AD in terms of cause of death in adults?

5 million Americans, 6th leading cause of death

How many people have hypertension under control?

64% of Americans

Prevalence of stroke in females over 65? Males?

8% females and 9% of males

How do you define cancer?

A group of diseases in which abnormal cellular growth affects specific organ systems.

What are kidney stones? What is the content of a kidney stone?

A hard mass found in kidney, made up of calcium and oxalate/phosphate

What are the 3 tests for diagnosing diabetes? Make sure that you know the values for normal, pre-diabetes, and diabetes.

A1C: - Normal = over 6.5 - Pre = 5.7-6.5 - Diabetes = under 5.7 FPG: - Normal = < 100 mg/dl - Pre = 100-126 mg/dl - Diabetes = > 126 mg/dl OGTT: - Normal = < 140 mg/dl - Pre = 140-200 mg/dl - Diabetes = > 200 mg/dl

What are the drugs that are prescribed the most for adults? For older adults?

Adults - cardiovascular, cholesterol lowering, antidepressants, analgesics Older adults - cardiovascular, cholesterol lowering, anti-acid reflux, anti diabetics, etc.

What ethnic groups have the lowest rate of cancer?

American Indian/Alaska natives

What is homocysteine?

Amino acid, high levels may be indicative of atherosclerosis and blood clots. High levels in the blood may promote cardiovascular disease

Percentage wise, how much energy is spent by basal metabolic rate? By physical activity and by the thermal effect of food?

BMR: 60-75% PA: 20-40% TEF: 10%

What are the nutritional interventions for dehydration?

Beverages contribute nutrients + fluids - Tea has antioxidants - Milk has calcium, protein, riboflavin, vit. D - Cranberry juice may reduce UTI - Fruit/veggie juice count towards fruit and veggie servings

How can osteoporosis be treated?

Bisphosphonates - inhibit bone resorption, increases bone mass density - Parathyroid hormone - Calcitonin - nasal spray - Raloxifene (SERM) selective estrogen receptor modulator

What is stroke?

Blood shut off to cerebral artery of the brain

How much does caloric expenditures decline/decade? What about physical capacity

CE: Declines ~2%/decade PC: declines 5-10%/decade

What is the C reactive protein? What are levels for good, average risk and high risk?

CRP is a substance produced by the liver that increases in the presence of inflammation in the body. - Below 1mg/L = good - 1-3 = average risk - > 3 = high risk

What is the definition of a stroke?

CV disease that affects the blood vessels supplying blood to the brain

What is the Mifflin-St. Jeer estimation formula? How accurate compared to the Harris-Bennedict formula?

Calculates the resting metabolic rate. More accurate than HB formula, 82% to 69%.

What needs to be said about salt for the food pyramid?

Choose lower salt food from each category

What is MNA? What type of questions are made to assess nutritional assessment? Which measurements are taken?

Combines 6 screening questions in stage 1 with 12 assessment questions in stage 2. - Take mid-arm and calf circumferences - Questions related to lifestyle

What does tobacco do to coronary arteries? How does it lead to hypertension?

Constricts coronary arteries. - Releases catecholamines which constrict blood vessels leading to hypertension.

How many Americans are over 65 now? By 2050?

Current: 17.4% > 65 By 2050: 19% > 65

How are people screened for osteoporosis?

DEXA (X-Ray)

What are the needs for postmenopausal women for iron? Does it go up?

Daily iron requirement decreases to 8 mg

What happens in taste and smell after one gets older? Who does worse men or women?

Decline with age. - Men decline begins ~ age 55 - In women > age 60

Does caloric expenditure decline or stay the same during adulthood?

Declines during adulthood (decrease in metabolic rate/activity level)

What are the protective effects of estrogen? What does estrogen decrease? What does it increase?

Decreases: - Production of cholesterol - Contraction of smooth muscle cells - Homocysteine Increases: - LDL catabolism - Insulin sensitivity - Release of nitric oxide

What can affect taste and smell in addition to age?

Disease/medications

Why is Vitamin D so important for so many conditions/tissues? What does every tissue and cell have? What is the normal concentration of Vitamin D in plasma? What is the percentage of Americans who are deficient in Vitamin D?

Every tissue and cell has a vitamin D receptor. - Normal conc. in plasma: 30ng/mL - 25-70% of Americans deficient

What are some of the nutrients that the adult population falls short in recommendations? Some taken in excess?

Exceed: protein, sodium... Don't get enough: fiber... Men exceed iron needs, women fall short.

What is the proposed mode of action for phytoestrogens?

Exert an estrogen like reaction on the body

How can stroke be recognized fast so you can call 911?

F - Face (uneven?) A - Arm (one arm drift down?) S - Speech (speech sound strange?) T - Time (call 911)

What percentage of fluids come from foods/drinks?

Foods ~19% Drinks ~81%

How does intake of soy reduce the risk of breast cancer?

Geinstein activates anti-tumor immune responses and reduces expression of immunosuppressive mechanisms in mice.

How is osteoarthritis treated?

Glucosamine with chondroitin, GAIT trial showed similar effects w placebo users - may help moderate to severe pain, vitamin C/D

Which type of tea has been found to help with kidney stones?

Green tea/herbal teas

What is the role of LDL? HDL?

HDL - stable, carries "bad" cholesterol away from arteries. LDL - sticks to artery walls and contributes to plaque build-up

What is atheroscleroisis?

Hardening of arteries due to plaque buildup

Name 3 countries worldwide with a high risk for diabetes? With a low risk?

High - Egypt, Saudi Arabia, Turkey. Low - Lithuania, Ghana, Liberia.

What information does the determine list provide? How is nutritional score calculated?

Identifying nutrition risk factors.

What are the main changes in plasma lipids for postmenopausal women?

Increases: - Total cholesterol - LDL - TG - No changes in HDL cholesterol

Why can some herbal treatments be dangerous?

Interfere with medications

What are the iron recommendations after menopause? Why do some older adults still have iron deficiency?

Iron needs decrease after menopause (8 mg) Can still have iron deficiency: - Iron less from disease/medications - Decreased acid secretion - Decreased calorie intake

Which is the country with the highest life expectancy? What number is the US?

Japan has highest life expectancy. USA is #34

What is osteoarthritis? Etiology? How is it different from osteoporosis?

Joint pain/stiffness as a result of flexible tissues at the end of bones wearing down. Etiology: - Cartilage loss, bone changes, hardening of soft tissues/inflammation Osteoporosis results in loss of bone, osteoarthritis causes bone/joint pain

What are the categories for LDL? Triglycerides?

LDL: < 100 mg/dL = optimal 100-129 = near/above optimal 130-159 = borderline high 160-189 = high 190 and above = very high Triglyceride: < 100 mg/dL = optimal < 150 = normal 150-199 = borderline high 200-499 = high 500/above = very high

What is the percentage of Americans with LDL cholesterol? With hypertension?

LDL: 1/3 HTN: 2/3

How many points are needed to score for malnutrition using the MNA?

Less than 17

What is the difference between life expectancy and life span?

Life expectancy - number of years someone is expected to live from a certain starting point Life span - the number of years that one person lives

What is the recommended diet for AD?

Mediterranean-DASH diet: - green leafy veggies - beans - whole grains - fish - poultry - olive oil - wine

What are the symptoms of heart attack in men? Women?

Men: - Chest pain - Left arm pain - Right jaw pain - Sweating - Nausea Women: - Chest/arm/back pain - Fatigue - Sleep disturbance - Jaw pain - Nausea - Dizziness - Anxiety - Edema - Fluttering - Sweating

What about Kava? Is it effective? Does it have side effects?

Muscle relaxant/anticonvulsant - Found effective for decreasing menopausal symptoms - Side effects: effect liver toxicity

Remedies to prevent stroke

Normalize blood pressure - Reduce overweight and obesity - Moderate alcohol intake

What is oxidized LDL? How does oxidize LDL initiate atherosclerosis?

Oxidized LDL creates an injury by burrowing into the artery wall, immune system sends inflammatory cells like monocytes to heal the injury.

What does Italy add to its recommendations that is not in the USA dietary guides?

Physical activity

What is the definition of dehydration?

Physiological state in which cells lose water to the point of interfering with the metabolic process

What are the differences in body composition between somebody 25 years old vs. somebody 75 years old

Protein: - 20-25: 19% - 70-75: 12% Water: - 20: 61% - 70: 53% Mineral mass: - 20: 6% - 70: 5% Fat: - 20: 14% - 70: 30%

What do plant stanols do?

Reduce chronic disease, lowers cholesterol

What is the recommendation about saturated fat? Should it be replaced with unsaturated carbohydrate?

Replacing SFA with polyunsaturated fat modestly lowers coronary heart disease risk...don't bother replacing it with carbohydrate.

Is there a relationship between alcohol and breast cancer in women?

Risk of breast cancer quadrupled with each daily glass of wine or beer.

What are the short term effects of diabetes? The long term effects?

Short term: - Blurred vision - Increased urination - Increased weight - Increased infections - Decreased wound healing - Hunger and thirst Long term: - Heart disease - Hypertension - Stroke - Blindness - Kidney failure - Poor circulation - Loss of limbs

What is kyphosis? What causes it?

Shrinking height - ~67% of vertebral fractures are asymptomatic - Results from compression/bone fracture in spine

What is myocardial infarction?

Shut off blood in heart (heart attack)

What are the guidelines for rehydration?

Slow - Provide 1/4 to 1/3 overall fluid deficict - Use water of 5% glucose solution - Thickened liquids count as fluid - Offering fluids hourly/w/ medication

What is responsible for 30% of cancers?

Smoking

What do the new dietary guidelines published in January 2016 say about sodium, saturated fat and dietary cholesterol?

Sodium: - DG: 2300mg (1500 if you have hypertension, are black, over 51, or have diabetes) Saturated fat: - less than 10%/7% Dietary cholesterol: no longer restricted

What is the difference between a stable and unstable plaque?

Stable plaques are less likely to rupture b/c they have a thicker fibrous cap.

What substance in tobacco is a stimulant? What substance in tobacco inhibits lung function?

Stimulant: nicotine Inhibits lungs: tar

What are the symptoms for AD?

Symptoms: excessive amounts of amyloid plaques and tangled nerves called neurofibrils, levels acetylcholine decreases which impairs memory, free radicals

What is sarcopenia? How is it diagnosed? What are the problems related to to sarcopenia?

Term for loss of LBM and strength associated with aging. - Increased risk of physical disability, poor quality of life and mortality - Diagnose with low muscle mass plus low muscle strength or low physical performance

What is the rate limiting enzyme for cholesterol synthesis in the body? What is the target for statins?

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

Know the different categories of cholesterol levels, for HDL and what are the good values for HDL?

Total: - Less than 200 mg/dL - desirable - 200-239 - borderline high - 240 and above - high cholesterol HDL: - Less than 40 mg/dL (men)/50mg/dL (women) - Low HDL cholesterol - 60 mg/dL and above - high HDL cholesterol

How much does the typical American consume in added sugars? What are individuals at increased risk for when they take a lot of sugar?

Typical American consumes 475 calories a day in added sugars. - Increases risk of diabetes, heart disease, obesity, gout

What is the etiology of dehydration?

Typically linked to illness or other problems - Diarrhea, sweating, deprivation

What nutrients are a concern for older age group?

Vit A, D, C, sodium, calcium, potassium

Why are older adults at risk for Vitamin D intake? Vitamin B12?

Vitamin D: 1. Limited exposure to sun 2. Institutionalization/homebound 3. Certain medicines Vitamin B12: - Lower levels of HCl and pepsin in aged persons (inability to split B12 from protein carriers) - Synthetic or purified B12 is not protein bound and is much better absorbed

What are the AHA recommendations for sugar for men and women?

Women: 6tsp/100cal/25g Men: 9tsp/150cal/38g

Can sarcopenia and obesity be together? What would be a big problem in this case?

Yes, leads to higher risk of metabolic syndrome than sarcopenia or obesity alone.

What percentage of lower calories are required for 51 and over?

~ 20% fewer calories

What is the percentage of adults in the US that drink alcohol? What is the rule in US for alcohol consumption? Canada?

~61% of US adults drink alcohol - US: drink in moderation - Canada: >4 drinks is risky