Nutrition E2-2

Selected possible causes of taste disturbance in the elderly

*Common Causes* Oral and perioral infections (e.g., candidiasis, gingivitis, herpes simplex, periodontitis, sialadenitis) Bell's palsyOral appliances (e.g., dentures, filling materials, tooth prosthetics) Dental procedures

Definitions and Demographics**

*From the US census Bureau and Social Security* Young old 65-74 (born 1936 - 1945) Old 75-84 (born 1926 - 1935) Oldest old 85+ (born before 1925) (Data from US census Bureau, Current Population reports, P23-209)

Food trends and Patterns**

*Increasing processed and purchased foods* 48.5% of food dollars are spent away from home *More sodium and fat, lower in fruits, vegetables, and whole grains* *Increase in portion sizes* *Weight and nutrient imbalances*

NHANES

*National Health and Nutrition Examination Survey* To assess the health and nutritional status of adults and children in the United States *The National Health and Nutrition Examination Survey (NHANES)* is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.

Women's Health**

*Reproductive years* Osteoporosis, heart disease, and some cancer are affected by specific hormones *Effects of pregnancy and breastfeeding* *Premenstrual syndrome* *Peri-menopause and menopause* - Choose foods that supply heme iron-more readily absorbed by the body - Choose enhancers of iron absorption such as vitamin C-rich foods. - Consume 400 micrograms (mcg) per day of synthetic folic acid

Nutrition in Adults

-Identify Prime targets for positive nutrition and health guidance -Prescribe healthful food regimens and caloric need in the healthy adult -Counsel on sources of nutritional information -Make science-based guidance recommendations from AHA, ADA, American Diabetes Association, ACS, USDA, and so on

Drugs can Alter Nutritional Absorption

Changing acidity of gastric juice Antacids inhibit iron absorption Altering gastric juices Cimetidine can improve fat absorption Altering GI tract motility Laxatives decrease absorption Inactivating enzymes Neomycin reduces lipase activity Damaging mucosal cells chemotherapy Binding to nutrients Antacids bind phosphorus

Functional Foods

Fruits and vegetables, flax seeds, fish oils, whole grains, certain spices, yogurt, nuts, soy, legumes Benefits beyond usual nutrient value Lower blood cholesterol or blood sugar, antioxidant or free radical scavenger, promote healthy GI tract, stimulate detoxification enzyme systems

Lifestyle and risk factors

Health in the United States has improved over the past 50 years Life expectancy has continued to increase; now 77.9 years Adult years are defined as 25 to 65 years

Nutrition as Preventative Strategy

Primary: Nutrition as first step in health promotion. Secondary: Risk reduction and slowing disease related complication to maintain functionality and quality of life Tertiary: Nutrition as medical therapy (ie, immune enhanced diet)

Physiological Changes

The 1% Rule: Organs lose 1% of their function each year after age 30 Change in body composition: increased fat and decreased muscle - Sarcopenic Obesity Sensory Losses Dysgeusia Hyposmia Eyesight: glaucoma, cataract, diabetic neuropathy and macular degeneration Neurologic Brain loses 5-10% of weight between age 20 and 90 Depression

Goals of NHANES**

*U.S. population-based estimates of:* 1. Health conditions 2. Awareness, treatment and control of selected diseases 3. Environmental exposures 4. Nutrition status and diet behaviors

Over Sample

-African Americans -Hispanics -Persons aged 60+ -Previously low income whites

Sample**

1. *Civilian, non-institutionalized household populational* 2. *Residents of all states and the District of Columbia* 3. All ages 5,000 individuals each year 70% response rate

INTERVENTIONS: FOOD ASSISTANCE PROGRAMS**

1. Food Stamps 2. Commodity Supplements 3. Senior's Farmers' market 4. Child and adult care food program 5. Emergency Food Assistance 6. Meals on wheels 7. Healthy People 2020

Collaborators

CDC (5 Centers) NIH (7 Institutes) USDA (3 Agencies) EPA FDA

Changes in Elder

Economic Fixed income Lack of transportation Social Widows tend to eat more Widowers tend to eat less Sedentary Lifestyle-Sedentary Death Syndrome, Physical Inactivity

Dietary Guidelines for Americans: Physical Activity

To reduce the risk of chronic disease, 30 min/day of moderate-intensity activity on most days To manage weight, 60 minutes of moderate to vigorous intensity activity on most days To lose weight, 60 to 90 minutes of daily moderate to intensity activity

What is NHANES**

*The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions.* The examination component consists of *medical, dental, and physiological measurements*, as well as *laboratory tests* administered by highly trained medical personnel. Findings from the survey are used to *determine the prevalence of major diseases and risk factors for diseases.* Information will be used to *assess nutritional status and its association with health* promotion and disease *prevention.* NHANES findings are also the *basis for national standards for such measurements as height, weight, and blood pressure* Data from this survey will be used in epidemiological studies and *health sciences research*, which help develop sound *public health policy*, direct and design health programs and services, and expand the health knowledge for the Nation.

Nutritional Needs i nElderly**

*Vitamins and Minerals* -B12- Atrophic gastritis (10-15% prev. >50 yrs.) decreases intrinsic factor -D- Synthesis mechanism of skin declines. Elderly spend less time outdoors -Calcium- 1200 mg/ day to help prevent Osteoporosis -Iron- Post menopause decreases need. Antacids and other medicines can bind iron. -Potassium rich diet can blunt the effect of sodium related hypertension (4700 mg/day) -Folate reduces homocysteine levels and atherothrombosis associated with Parkinson's and Alzheimer's

Metabolic sx

*Waist circumference* -Men > 40 inches -Women > 35 inches *Blood pressure ≥130/85 mmHg* *Fasting blood glucose ≥ 100 mg/dL* *Triglycerides >150 mg/dL* *HDL* - Men < 40 mg/dL - Women < 50 mg/dL

Assessments**

*Weight change* Noticeable or sudden weight loss or weight gain Complaints of changes in taste and smell; Loss of taste and smell (which enhances taste) *Loss of appetite/smaller appetite:* "the tea and toast" scenario *Constipation*: Food moves more slowly through an aging digestive tract. Medication induced constipation. *Disease based Diets*: Cardiac, Diabetic, Neurological impairmentand swallow. *Medication*: can interfere with the body's ability to absorb nutrients from food, and impair the body's ability to excrete minerals. *Level of physical activity/exercise:* Strength training exercise + multivitamin can increase appetite *Mobility/dexterity problems*: Difficulty preparing meals and shopping for groceries. Difficulty holding utensils. *Loneliness/depression*: Eating is a social activity. Widows/ Widowers *Dining environment/food presentation* A pleasant environment and appetizing-looking food increases a person's enjoyment of meals

NHANES Data Central to Health Policy and Practice

-No other source of actual measurement data -Ability to integrate findings from each interview and exam component -High quality of data collection, processing and analysis -Responsive and relevant to current and future data needs

Chronic Diseases Linked to Lifestyle

-Overweight (BMI, 25-29) and obesity (BMI 30 or more) -Hypertension -Diabetes and pre-diabetes -Metabolic syndrome -Lack of physical activity -Smoking

Condition of Risks

-Pregnancy -Alcohol and drug dependency -Chronic illness or disability -Food insecurity -Vegan or other restrictive diets -Inability or unwillingness to learn to prepare food

Dietary Guidelines for Americans

1. Carbohydrates: 45% to 65% of kilocalories, complex carbohydrates, 14 g fiber per 100 kcal 2. Fruits and vegetables: variety 3. Fat: 25% to 35% of kcals, <10% of kcals from saturated fatty acids, low trans-fatty acids 4. Protein: 10% to 35% of kcals, lean animal sources, increase plant sources, 3 servings dairy products or calcium-fortified foods

Leading Causes of Death and Disability

1. Heart disease 2. Cancer 3. Cerebrovascular disease 4. Chronic lower respiratory disease 5. Accidents 6. Diabetes

Diseases which alter sense of taste

Alzheimer's Disease Bell's palsy Damage to vocal chords Epilepsy Head trauma Korsakoff syndrome Multiple Sclerosis Parkinson Disease Bromley, Steven. "Smell and Taste Disorders: A Primary Care Approach." American Family Physician http://www.aafp.org/afp/20000115/427.html

Nutritional Recommendations in Elderly

Basic metabolic rate decreases 3% per decade, yet low kilocalorie diets are often nutrient deficient. Avoid unpasteurized milk products Avoid uncooked eggs and undercooked meats and fish Maximum 1500 mg sodium per day Fiber- 14g. Per 100 kcal. Fluid - minimum of 1500 ml/day

Cardiovascular disease Diabetes Bone status, osteoporosis Oral health Vision and eye diseases Hearing and balance Fitness and strength Allergies

Cardiovascular disease Diabetes Bone status, osteoporosis Oral health Vision and eye diseases Hearing and balance Fitness and strength Allergies Nutrition Anthropometry Mental health Risk behaviors Reproductive health Environmental exposures Infectious diseases Spirometry

The Wellness Year

Dietary Guidelines for Americans MyPyramid food guidance system Wellness Food security Health-related quality of life (HRQOL)

Risk Factors for Malnutrition in Older Adults

Disease Eating poorly Tooth loss or mouth pain Economic hardship Reduced social contact Multiple medications Involuntary weight loss or gain Needs assistance Elderly- over 80

Oral/ Gastrointestinal Changes

Dysphagia Edentulous Xerostomia Achlorhydria Diverticulitis Constipation Thirst mechanism

New Goals**

Information collected in this survey will help the *Food and Drug Administration decide if there is a need to change vitamin and mineral fortification regulations for the Nation's food supply.* National programs to *reduce hypertension and cholesterol levels continue to depend on NHANES* data to steer education and prevention programs toward those at risk and to measure success in *curtailing risk factors associated with heart disease*, the Nation's number one cause of death. New measures of *lung function will further our understanding of respiratory disease* and better describe the *burden of asthma in the United States*

Men's Health

Leading causes of death: heart disease, prostate cancer, and lung cancer Men develop heart disease at a younger age than women Regular exercise and weight-bearing exercise Dangers of iron overload

Life Expectancy

Life expectancy has increased by 30 years in the 20th century Those born today are expected to live to age 77.9 Women who reach age 65 can expect to live 19.9 more years (84.9 years old) Men who reach age 65 can expect to live 17.2 more years (82.2 years old) Growth in greater than 65 group will be 3.5 times US population growth rate Currently, there are 50,000 centenarians, many of whom live independently

Accomplishments

Past surveys have provided data to create the growth charts used nationally by pediatricians to evaluate children's growth. Have been adapted and adopted worldwide as a reference standard Blood lead data were instrumental in developing policy to eliminate lead from gasoline and in food and soft drink cans. Recent survey data indicate the policy has been even more effective than originally envisioned, with a decline in elevated blood lead levels of more than 70% since the 1970s. Overweight prevalence figures have led to the proliferation of programs emphasizing diet and exercise, stimulated additional research, and provided a means to track trends in obesity. Data have continued to indicate that undiagnosed diabetes is a significant problem in the United States. Efforts by government and private agencies to increase public awareness, especially among minority populations, have been intensified.

Food Trends and Patterns**

• *Increasing processed and purchased foods* • *48.5% of food dollars are spent away from home* • *More sodium and fat, lower in fruits, vegetables, and whole grains* • *Increase in portion sizes* • *Weight and nutrient imbalances*