1. XNB151
Food and
Nutrition
Velazquez, An Old Woman Cooking Eggs, 1618

2. Adult
Elders
Society
WorkmatesChildren
Community
2

3. Credit: RAMON ANDRADE 3DCIENCIA/SCIENCE
PHOTO LIBRARY

4. FOOD
Average volume
of soft drink
consumed per
person per yr
Fast food
burger fat
content is
twice the
level
1970
PORTION
SIZE
Standard
packet of
chips
INACTIVITY
 in number of cars driven
to work each day in
Australian capital cities
70%
(>1.4 million
cars)

6. # WHO 2000, AIHW (2004)
*Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data)
6
Classification # BMI (kg/m2) IBW % * Risk of Chronic
Disease
Underweight <18.5 >10% below* Low (but other
risks)
Normal range 18.5-24.9 desirable Average
Overweight >25
pre-obese 25.0-29.9 (10-19% above*) Increased
obese class I 30.0-34.9 (>20% above*) Moderate
obese class II 35.0-39.9 Severe
obese class III >40 Very severe

7. BMI classification in kg/m2
7
Asian Pacific Is.
<18.5 <19.9 Underweight
18.5-23.9 20.0 - 26.9 Normal weight
24.0-26.0 27.0-32.9 Overweight
27.0-39.0 33.0-39.9 Obesity

8.  BMI measures don’t
accurately represent
healthy weights of
people who:
 are athletes with ↑
muscle mass
 have ↓ muscle mass
 have dense, large bones
 are dehydrated or over-
hydrated

9. 1. Waist circumference (AIHW,
2005) > 18 y
 >94 cm (M) >80 cm (F) –
abdominal overweight
 >102 cm (M) >88 cm (F) –
abdominal obesity
2. Waist: hip ratio
 visceral fat around organs vs.
subcutaneous fat on hips
 optimalWHR is < 1 (M) or <
0.8 (F)

10. energy intake > energy expenditure
 Not a lot extra required to allow slow weight
gain over the years
↑ food intake = ↑ wt gained
+420 kJ/day = +4.5kgs/yr

11.  ↑ Portion sizes
 The food industry including
advertising
 Eating out
 ↑Variety/flavours of food
 ↑ Availability/affordability of energy
dense foods
 Higher socio-economic status
 The “killer combination of salt, fat &
sugar”
 Less restrictive clothing?
 High fructose corn syrup – rarely
used in Aust
(David Kessler,The End of Overeating; Bray & Champagne, 2005,
Beyond energy balance)

12.  ↑ Car ownership
 Sedentary Leisure activities
 Technological innovations →↓
manual jobs
 ↑Affordability of washing machines
etc
 Education
 Shopping changes
 Houses/shopping/work places
warmer
 Fear for children’s safety

13. >>3 X ↑ Risk 2 -3 X ↑ Risk Up to 2 X ↑ Risk
Type II Diabetes
Gall-bladder
disease
Dyslipidemia
Insulin resistance
Breathlessness
Sleep apnoea
Cardiovascular
diseases
Hypertension
Osteoarthritis (in
knees)
Cancer
Impaired fertility
Lower back pain
Risk of anaesthesia
complications
Foetal defects
associated with
maternal obesity
13

14. 1Kg = 32.3 MJ
 so to lose 1Kg/ wk you need to burn off 32.3 MJ/ wk
Activity Av E expenditure
(MJ/hr)
sitting easy 0.4
'fidgeting' up to: 0.5
walking 1.0
dancing 1.2
cycling 1.7
swimming 2.4
skiing cross country (max) 4.2
14

15. Goal: to lose 0.5 - 1 Kg /wk
So (in theory):
 To lose 1Kg = 32.3 MJ, you need to  energy intake by 4.6
MJ/d:
e.g.
Consume 4.0 - 5.0 MJ/d (women) (from 8-9MJ)
Consume 6 - 8 MJ/d (men) (from 10- 12 MJ)
 Improve weight maintenance with physical activity &
behaviour modification
15

16. 1. An absolute reduction from baseline of
2000kJ/d
2. A relative reduction from baseline eg 25%
3. An intake below that required for weight
maintenance (4,500-5,000 kJ/d for
women, 5,500-6000 kJ/d for men)
4. Qualitative modifications e.g. swap
energy dense for less energy dense foods
or remove reduce portion sizes
16

17.  Genes
 Hormones
 Hunger
 Psychological
Factors
 Social Factors
 Disease
 Medications
Why is something so simple so
hard?

18. Weight Loss Interventions
Diet &
Nutrition
Activity
Behavioural/Co
gnitiveTherapy
Pharmaco
therapy Surgery

19.  Individual responsibility vs. obesogenic
environment
 Both need to be considered
 Multiple strategies needed
http://swapit.gov.au/resources
©2010 by the Regents of the
University of California

21.  Increase in the absolute & relative number of older
people in both developed and developing countries
 2000: 580 million > 60 y
 2020: 1000 million > 60 y
In Australia Proportion of the Population 65+Y
 1861: 1%
 1900: 4%
 1970: 8%
 2001: 13%
 2052: 25%

22. Social challenges
Economic challenges
Health challenges

23.  Chronological age: years since birth
 Biological age: decline in function that occurs
in every human with time
 Compression of morbidity
 Evidence of improvements in biological
age → not only genes but also lifestyle
can influence ageing

24. NO
 Age 65 y life expectancy  15 & 19 y in M & F
 Evidence interventions have worthwhile
advantages in elderly age groups
 E.g. increased activity, smoking cessation,
reduced saturated fat intake, reduced sodium,
weight reduction
Mann JM,Truswell ST, eds. Essentials of human nutrition. NewYork, Oxford
University Press, 1998:499–511.

25.  Oral Health
 Xerostomia
 Dental problems
 Gastrointestinal
  motor function & muscle tone
  digestive capacity
 Diverticula
 Metabolic
  Glucose tolerance
  Basal metabolic rate
 Cardiovascular
  heart muscle, vessel elasticity
  LDL cholesterol to 60 y (M) 70 y (F)

26.  Sensory
 Diminished taste, smell, sight, hearing & touch
 Renal
  Kidney function
 Bone
  BMD
 Body composition
  % Muscle mass
  % Fat mass
 Immune system
 T-cell function
 Neurologic
 Impaired cognition

27.  A condition or syndrome that results from a
multi-system reduction in reserve capacity to
the extent that a number of physiological
systems are close to, or past, the threshold of
symptomatic clinical failure
 Increased risk of disability and death from
minor external stresses
 6 to 25% of 65 year olds and 25 to 40% of 80Y +
5/15/2013 27

28.  Poor appetite
 Fatigue
 Physically inactivity
 Slow and unsteady gait with ↑risk of falling
 Increased risk of
 impaired cognition
 Sarcopenia
 Osteopenia
 Fracture
 Depression
 Reduced lifespan
5/15/2013 28

29.  Dietary patterns generally similar to or
healthier than those of younger counterparts
 Intakes of cereals, fruit, vegetables & milk
below recommended
 Need for more recent research
 See tables 27.2 and 27.3 ofWahlqvist edition 3
for details
5/15/2013 29

30.  Diminished ability to defend against
dehydration with age
 Reduced thirst sensation
 Lower % body water
 Impaired renal function
 Impact of conditions
 Urinary problems
5/15/2013 30

31.   Sense of smell
 Taste buds
 Alterations in brain control of appetite
 Alterations in signals from stomach
  gastric emptying rate

32.  Cognitive impairment
 Depression
 Bereavement
 Alcoholism
 Cholesterol phobia
 Choking phobia/Food phobias
 Sociopathy (loss of locus of control)
 Food faddism

33.  Low SES groups
 Older men alone
 Social isolation,
lonely
 Poor nutritional
knowledge
 Institutionalized
 Limited food storage
 Shopping difficulties
 Inadequate cooking
skills
http://www.guardian.co.uk/society/2009/jul/01/pu
blic-services-reforms

34.  Disability/impaired motor performance and
mobility
 Poly-pharmacy
 Anorexia
 Chewing problems
 Swallowing problems
 Chronic disease
 Increased metabolism
 Malabsorption -other digestion problems
 Physical Disability
 Reduced thirst sense
 Impaired taste/smell sight

35. Older adults acceptable range: 23-28 kg/m2
Grade 1 malnutrition or PED: 17–18.5 kg/m2
Grade 2 malnutrition or PED: 16–17 kg/m2
Grade 3 malnutrition or PED: <16 kg/m2

36.   in lean mass &  abdominal fat
 Caused by illness &/or inadequate food intake
 More common amongst institutionalized
 Underweight increases risk of
 Hip fracture
Reduced mobility
Increased Mortality
 Even those with apparently adequate fat and
muscle are at increased risk if recent, rapid
weight loss

37. A systematic skeletal disease characterized by low
bone mass & micro-architectural deterioration of
bone tissue with a consequent increase in bone
fragility & susceptibility to fracture (Consensus
Development Conference, 1993)

40.  Nutrition
 Physical activity
 Alcohol
 Smoking
 Genetics
 Ethnicity
 Hormonal changes
 Age
 Disease

41.  Essential to achieve peak bone mass
 Attenuates loss of BMD with age
Age RDI (mg/d)
Males
19-70 y
> 70 y y
1000
1300
Females
19-50 y
51 + y
1000
1300

42.  Vitamin D
 Regulator of calcium balance
 Essential for normal mineralization of bone
 Not widespread in food-chain
 80-90% of requirements from sunlight
 People with limited sun exposure most at risk

43.  BMI/Body weight
 Positive association between BMI/body weight &
BMD of spine & femur
 Could be due to
▪  bone mass/muscle strength
▪  nutrient intake
▪ Forces on bone
▪ Oestrone
Credit: ZEPHYR/SCIENCE PHOTO
LIBRARY

44.  PhysicalActivity
 BMD ↑ to adapt to mechanical
stress
 BMD Decreases when stress is
removed
Credit: DAMIEN
LOVEGROVE/SCIENC
E PHOTO LIBRARY

46.  In older adults, weight-bearing
& resistance exercise ↑ LBM &
bone density
 Prevention & treatment of
obesity, CHD, type II diabetes,
osteoporosis
 Prevention & reversal of
sarcopenia
 Increased appetite & energy
expenditure
 Mental & emotional benefits
 Functional status &
independence
 Check with GP firstCredit: MAURO
FERMARIELLO/SCIENCE PHOTO
LIBRARY

47.  Emphasize healthy traditional vegetable- and
legume-based dishes
 Limit traditional dishes/foods heavily
preserved/pickled in salt & encourage use of herbs
and spices
 Introduce healthy traditional foods or dishes from
other cuisines

48.  Select nutrient dense foods such as fish, lean meat,
liver, eggs, soy products, & low fat dairy, yeast-
based products (e.g. spreads), fruit & veg, herbs &
spices, whole-grain cereals, nuts & seeds
 Consume fats from whole foods. Where refined fats
are necessary for cooking, selects from liquid oils,
including those high in -3 & -6 fats

49.  Enjoy food & eating in the
company of others. Avoid the
regulatory use of celebratory
foods.
 Encourage the food industry &
fast-food chains to produce
ready-made meals low in
animal fats
 Eat several (5-6) small non-
fatty meals
 Avoid dehydration by
regularly consuming fluids and
foods with a high water
contentCredit: MARTIN RIEDL/SCIENCE PHOTO LIBRARY

50.  Transfer as much as
possible of one’s food
culture, health knowledge
& related skills to one’s
children, grand-children &
the wider community
 Be physically active on a
regular basis & include
exercises that strengthen
muscles & improve
balance
http://www.thegoodfoodbully.com/2010/09
/its-my-grandmas-recipe.html