Adult nutrition and its management of nutritional disorders in adult

1. Nutrition
and
management in aged
RVS Chaitanya koppala

2. •Health is defined as the
ability to function and live
outside an institution.

3. •Aging is a gradual process
that reflects the influence
of genetics, lifestyle, and
environment over the
course of the lifespan.

4. •Adults generally need
fewer calories with each
passing decades.

5. Stages of adults:
• Early years – 20s to 30s
• Middle years- 40s to 50s
• Older years- 60s to 70s
• Oldest years- 80s and 90s

6. • State of health at any age is influenced by what is
eaten.
• One cannot have the best of health unless one eats
wisely.
• Maintenance and repair is the theme for nutrition
and the adult.
• Child grows taller as he matures, adult lose stature.

7. • The cumulative effects of maturation,
disease, medication and previous health
practices influence the nutrient needs of
adults.

8. • The mechanism of aging is a decline
in the number cells along with the
changes within the cells that damage
the cellular organelles and changes
in the basic genetic material that
affect cell replication.

9. • The control of chronic
conditions with medication
and diet is a concern for many
adults.

10. • The total nutrients needed for
replacement and repair of the
mature adult are more than the
total nutrient needs of children
except for calcium, phosphorus
and vitamin D.

11. • The reduction in basal
metabolism observed as a change
accompanying aging and a
reduction in activity explain the
reduction in the suggested caloric
intake.

12. Average women with sedentary
lifestyle
AGE CALORIES
23-50 1600-2400
51-75 1400-2200
75 and above 1200-2000

13. Average men with sedentary lifestyle
AGE CALORIES
23-50 2300-3100
51-75 2000-2800
75 and above 1650-2450

14. Adult
• 1600 calories a day is about right for many
sedentary women and some older adults.
• 2200 calories a day is about right for
moderately
• active women, and most men.
• • 2800 calories a day is about right for active
men
• and some very active women.

15. Effects of aging
EFFECT ON NUTRITION CAUSED BY ORGAN INVOLVED
ability to taste salt and
sweets
taste buds Tongue and nose
Palatibility of food taste and olfactory nerve
endings
Food intake
Taste and smell
Reduced sense of thirst/dry
mouth
saliva production Salivary glands
Difficulty chewing Muscle contractions may
malfunction
esophagus
Bioavailability of vitamins,
minerals, proteins
HCl secretion and intrinsic
factor
Stomach
Adrug doses (adjustments
possible to avoid
overdosing)
production of drug-
matabolizing enzymes
Liver

16. EARLY YEARS (20s TO 30s)
• Their lifestyles are more time-restricted and
positive health behaviors such as regular meal
pattern and exercise may fall by the wayside.
• These years marks a transition from one stage
of the life span to another; young adults
separate from their family of origin; focus on
personal goals, and often face reproduction
decisions.

17. • Women bear children during these years
• For women , the recommended dietary
allowance for energy is 2200 kcal daily.
• For men, 2900 kcal.
• This reflects the typical differences in body
weight and lean body mass of men and women.

18. • Vitamin and mineral needs do not significantly
change.
• Calcium and phosphorus needs for men and
women decline after age 18 because skeletal
growth is almost complete.

19. MIDDLE YEARS( 40S TO 80S)
• Marked by a continuation of family demands and
career involvement.
• Kcaloric needs decline as lean body mass is lost
and replaced by body fat that is less
metabolically active.
• Body fat increases can be slowed by exercise and
strength training to continue maintenance of
lean body mass.

20. • After age 50, daily energy drop from 2200 to
1920 kcal for women.
• From 2900 to 2300 kcal for men.
• It is a challenge to meet the same nutrient
needs with reduced kcaloric intake.

21. OLDER YEARS(60S, 70S AND 80S)
• As our life span increases in years, senescence
(older adulthood) is for many a time of life for
continued professional or career
advancement and recreational enjoyment.
• Others are in transition, adjusting to
retirement and settling into new patterns of
activities.

22. • During these later years, individuals may struggle
with deaths of family members and friends and
adjustment to retirement.
• Disorientation or senility often associated with
aging may be caused by improper use of
medication, marginal nutrient deficiencies.
• Nocturia (inability to get to the toilet on their
own)

23. • Fluid requirements in older adults remain the
same as in younger adults ( about 8 cups a day)
unless a medical condition.
• Nutrition status may be affected by restricted
access to food and ability to prepare meals.
• Shopping may be difficult w/o transportation and
mobility to walk through store may be limited.

24. • Adults may no longer have interest in cooking.
• Many continue to live in their own home with
family members, some opt for retirement
communities and others.
• Change in ability of the body to either process or
synthesize certain nutrients.
• Adults need more exposure to sunlight.

25. OLDEST ADULT (80S AND 90S)
• Aging continue to reduce the ability of the body
to absorb and synthesize nutrients.
• Malnutrition and underweight becomes concerns
during this stage.
• Food preparation becomes physically difficult to
accomplish.
• Kcaloric intake may diminish.

26. • Illness accompanying medications may reduce
appetite
• Malnutrition is associated with complications
• Risk for dehydration
• Decrease ability of kidney to concentrate urine
• Limited movement

27. ADULT HEALTH PROMOTION
• Adequate intake of nutrients found in foods
(rather than in supplements)
• Relationship between diet and disease
• Moderate kcaloric intake coupled with regular
exercise for physical fitness and obesity
prevention.

28. DETERMINE

29. Adults are risk for….

30. • Disease
• Eating poorly
• Tooth loss or oral pain
• Economic hardship
• Reduced social contact
• Multiple medications
• Involuntary weight loss or gain
• Needs assistance with self-care
• Elderly person older than 80 years

31. COMMON DISEASES IN
ADULTS

32. HEART DISEASE
• Commonly considered a disease in men.
• The increase of cholesterol increases the risk
of cardiovascular disease.
• A heart-healthy diet that is low in fat and
saturated fat, ric in fruits, vegetables and
whole grains.

33. CANCER
• 2ND
leading cause of death.
• Lung cancer, breast cancer, colorectal cancer
are 3 leading causes of cancer deaths.
• High intake of fruits and vegetables may
protect against cancers.

34. • Rich in fruits, vegetables and whole grains is
protective against breast cancer.

35. DIABETES
• Diabetes increase the risk of heart disease
• Obesity is implicated in the majority of cases
of type 2 diabetes
• Weight management and a heart healthy diet
are cornerstone of treatment.

36. OSTEOPOROSIS
• Osteoporosis is a disease that is characterized by a
decrease in total bone mass and deterioration of bone
tissue which leads to increased bone fragility and risk
of fracture.
• Between 30 to 35 years of age, peak bone mass, the
most bone mass a person will ever have is attained.
• During the first 5 years or so after onset of
menopause, women experience rapid bone loss that is
related to estrogen deficiency.

37. • The vertebrae, hip, and wrist are most
susceptible to fracture.
• Decrease in stature and deformity reduce lung
capacity and abdominal volume, which may lead
to chronic back pain, and decrease tolerance in
activity.
• Weight bearing exercise and calcium intake are
important for building and strengthening bones.

38. PROSTATE CANCER
• Is associated with fat intake , particularly
saturated fat.
• Men plder than 40 should be encouraged to
undergo an unnual digital rectal examination
or other forms of prostate cancer screening
because overt symptoms may not occur until
cancer ia advanced.

39. ADULT DISEASES AND
CONDITIONS
• Aging Eye (including cataracts,
glaucoma and macular
degeneration)
• Alzheimer’s and Other Dementias
• Anemia
• Blood Pressure (Hypertension)

40. • Kidney Disease
• Lung Diseases (including COPD)
• Memory Loss
• Menopause
• Osteoporosis

41. • Stroke
• Thyroid Disorders
• Urine and Bladder Problems

42. The key driver for eating is of course hunger but what we
choose to eat is not determined solely by physiological or
nutritional needs.
• Biological determinants such as hunger, appetite,
and taste
• Economic determinants such as cost, income,
availability
• Physical determinants such as access, education,
skills (e.g. cooking) and time

43. • Social determinants such as culture,
family, peers and meal patterns
• Psychological determinants such as
mood, stress and guilt
• Attitudes, beliefs and knowledge
about food

44. Nutrition
assessment in the
elderly people

45. • With age, metabolism decreases
• Body composition changes
• Muscle mass decreases as adipose tissue increases
• Results in 2% deceased metabolic rate per decade
• Decreased physical activity – less energy
expenditure
Aging and Energy Needs

46.  30% of elderly consume less kilocalories than
recommended (Lengyel et al 2008)
 Decreased intake due to :
 Loss of appetite – depression, dementia
 Medication-induced anorexia
 Impaired taste perception
 Decreased density of taste buds (Winkler et al 1999)
 Higher thresholds for detection of tastes
 Loss of teeth
 Socioeconomic factors or functional disability effecting
 shopping and meal preparation .
Nutrient Consumption

47. Malnutrition is closely related to increased mortality and
morbidity
• Greater susceptibility to infection and longer hospital stays
Escott-Stump 2008), increased risk of medical and surgical
complications (Baker and Wellman 2005), increased risk of
pressure ulcers, hip fractures
(Escott-Stump2008)
• Incidence of malnutrition estimates range from 20 – 78 %
(Bouillanne et al 2005)
Incidence of Malnutrition

48.  Those with low lean body mass – about 25%
of elderly population over the age of 65
 Loss of muscle strength,
physical inactivity, slow or unsteady gait,
poor appetite, unintentional loss of weight,
impaired cognition and depression
(Escott- Stump 2008)
 Proper nutrition can help correct, but
physical activity is also necessary
Frail Elderly or FTT

49.  Compared to 20yr olds, 80yr olds need
 1000 to 1500kcals less in men
 600 to 800kcals less in women (Wakimoto et al, 2001)
 Protein needs remain same with age or slightly higher
(Elmadfa and Meyer 2008)
 0.8 to 1gm/kg body weight
 Kilocalorie protein supplement (i.e.Boost, Ensure) may be
helpful in preventing muscle wasting with inadequate total
kcal intake (Evans 2004)
 Fat intake among the elderly is greater than the
recommended 35% or less of total kilocalories
(Meydani 2004)
Macronutrient Needs

50.  Vitamin and mineral needs remain unchanged with
Age
 Decreased food intake often results in deficient intakes of
micronutrients
 50% of older persons have lower than recommended
intakes of micronutrients (Escott-Stump, 2008)
 80% of elderly persons have inadequate intakes of at
least on nutrient (Guigoz et al 2004)
 Digestion, absorption, and synthesis of
micronutrients are decreased (Elmadfa and Meyer, 2008)
Aging and Micronutrient Needs

51. Micronutrients of Concern
Vitamins
1 . Vitamin E
2 . Vitamin C
3 . Vitamin D
4. Vitamin A
5. Thiamine
Minerals
1 . Selenium
2 . Zinc
3 . Calcium
4 . Iron

52.  High homocysteine levels resulting from B6, B12,
folate deficiencies linked to increased cardiovascular
disease risk and decreased mental agility
 Folate deficiencies linked to increased dementia and
depression (D’Anci et al 2004)
 Excessive folate intake can mask B12 deficiency
 Corrects hematological signs of deficiency but not
neurological signs
 Neurological signs include fatigue, malaise, vertigo,
cognitive impairment (Clarke et al 2003)
Deficiency Risks

53. • Diuretics increases water-soluble vitamins
losses as urinary excretion is increased
• Thiamine is especially at risk of becoming
deficient due to diuretics
• Low dose thiamine supplement in the elderly
on diuretics may be useful in preventing
deficiency
(Escott-Stump 2008)
Thiamine and other water soluble vitamins

54.  Commonly deficient – Lengyel et al 2008
found 10%, 84%, 49% of subjects deficient respectively
 Frail elderly are more likely to be deficient vitamin E and A
(Michelon et al 2006)
Centenarians are more likely to have high levels of Vitamin E
and A (American Dietetic Association 2005)
Needed for drug metabolism and detoxification
Vitamins A, E, and C

55.  Vitamin C, E, beta-carotene needed in adequate supply for
decreasing oxidative damage to tissues and cells including
immune cells
Balanced diet seems to be more effective
than supplementation for improved immune function but
supplementation maybe effective
Antioxidants

56.  Bone mass decreases with age especially in women
resulting in osteoporosis
 Direct health care cost of $12-18 billion each year just
for fractures (USDHHS 2004)
 Absorption of calcium and vitamin D effected by age -
receptor expression in duodenum decreases
Vitamin D synthesis decreases (MacLaughlin et al 1985)
 Less time spent exposed to sunlight (Escott-Stump 2008)
 Vitamins A and K, and magnesium effect bone health as
well, but more research needed (American Dietetic
Association 2005)
Calcium and Vitamin D

57.  Depression in the elderly is associated with low
levels of selenium (Gosney et al 2008)
 Low levels of selenium, zinc, and iron linked to
reduced cell-mediated immune response
(Wintergerst et al 2007)
Low zinc intake associated with increased wounds
and severity (Tobon et al 2008)
Selenium, Zinc, Iron

58. Evaluating Malnutrition: Clinical/History
• Age
• Weight (current &usual)
• Dentition
• Dysphagia
• Skin condition
• Constipation/Diarrhea
• Current medications
• I/Os
• Changes in appetite
• N/V, indigestion
• Pain
• Infection
• Motor coordination
• Morbidities

59. Evaluating Malnutrition:
Lab Work
• Glucose
• C-reactive protein
(CRP)
• Ca++, Mg++
• N-3, K+
• H&H, serum Fe
• Serum folate
• Serum homocysteine
• Albumin,prealbumin,
or transthyretin
• Cholesterol

60. • Increased total number of medications associated
with decreased appetite (Elmadfa and Meyer 2008)
• Evaluate for alcohol abuse
 Can cause severe deficiencies of thiamine, folate, vitamin
B12, and zinc
 May not admit to true amount being consumed
• Screen for caffeine use
 May promote cognition
 Excessive use can have diuretic effect
(Escott-Stump 2008)
Further Recommendations for Screening and
Treatment

61. THANK YOU