1 dnt 200 nutrition for health sciences nutrition through the life cycle part 2

1

DNT 200NUTRITION FOR HEALTH

SCIENCES

NUTRITION THROUGH THE LIFE CYCLE

PART 2

2


The four stages of man are infancy, childhood, adolescence, and obsolescence

Bruce Barton (1886 - 1967)

American writer, congressman

3


4

NUTRITION THROUGH THE LIFE CYCLENutrition for children and teenagers

• Early and middle childhood– Growth and nutrient needs

• Appetite fluctuates greatly– Will adjust their energy intakes at successive meals– Can be highly variable from meal to meal but is consistent on a day to day

basis– Overweight children may not adjust their intakes appropriately -- may eat in

response to external clues

• Child will need and demand much more food during periods of rapid growth

• Steady growth during childhood is reflected in gradually increasing needs for all nutrients

5


Nutrition for children and teenagers• Early and middle childhood (con’t)

• Before adolescence, children accumulate stores of nutrients– During adolescent growth spurt, their nutrient stores cannot keep

pace with demands for rapid growth– Draw upon stores accumulated earlier -- especially calcium

• To provide all needed nutrients, a variety of foods from each food group is recommended

• Parents are challenged to foster development of healthy eating habits in child

6



• Every meal is important in a child’s life– Concentrated sweets must be limited in the child’s diet if needed

nutrients are to be supplied -- if permitted, tooth decay and/or obesity may result

• In US children and adolescents, iron deficiency anemia is the most prevalent nutritional deficiency

– Is decreasing because of» Increased breast feeding and increased use of iron fortified formula» WIC -- provides iron-rich foods during infancy

7


• Early and middle childhood (con’t)– Encourage iron-rich foods

» Drink milk only to ensure adequate calcium and riboflavin intakes

» After age 2, change to low fat milks and use Calories for other foods

» Lean meats» Fish» Poultry» Eggs» Legumes

8


• Early and middle childhood (con’t)– Nutrient deficiencies and behavior

• Iron deficiency– Usually diagnosed only after deficiency has progressed to anemia– Child’s brain is highly sensitive to lowered iron concentrations, long before

blood effects appear» Shortening of attention span» Reduction in overall intellectual performance» Irritability» Aggressiveness» Disagreeability» Withdrawal

9

NUTRITION THROUGH THE LIFE CYCLENutrition for children & teenagers

• Early and middle childhood (con’t)• Lead poisoning

– Can cause iron deficiency anemia -- and iron deficiency anemia impairs the body’s defenses against lead absorption

– Anemia brought on by lead poisoning may be mistaken for simple iron deficiency

– Mild lead toxicity has non-specific effects -- diarrhea, irritability, fatigue, reduced ability of blood to carry oxygen

– With higher levels, signs become more pronounced -- yet still difficult to pinpoint to a cause

» Learning disabilities develop» Behavior problems manifest

10


• Early and middle childhood (con’t)• Lead poisoning

– Even greater levels can cause» Irreversible nerve damage» Paralysis» Mental retardation» Death

– Prevention» Prevent hand-to-mouth ingestion in contaminated environments -- keep

small children from putting dirty or old painted objects in their mouths» Make sure children consume nutritious foods consistently

11

NUTRITION THROUGH THE LIFE CYCLENutrition for children & teenagers

• Early and middle childhood (con’t)– Hunger and behavior

• Children who eat a nutritious breakfast function better than their peers who do not

• By late morning, discomfort from hunger may become distracting even if a child has eaten breakfast

• Average child up to the age of 10 or so needs to eat every four to six hours to maintain sufficient blood glucose to support the activity of the brain and nervous system -- child’s liver can only store about 4 hours worth of glycogen

12


Nutrition for children & teenagers

• Early and middle childhood (con’t)– Food allergies

• Incidence– Highest in first several years of life– Declines with age

• About 5% of young children are diagnosed with food allergies

• Often are inherited

13


• Early and middle childhood (con’t)

– Food allergies• Occurs when a whole food protein or other large

molecule enters the system without being further digested

– Body’s immune system reacts as it does to an antigen -- produces antibodies, histamines, or other defensive agents

– Allergies are diagnosed from examining antibody production, not from evaluation of symptoms only

14



– Food allergies• Identifying foods that cause an

immediate reaction is easy– Symptoms correlate closely with the timing

of eating the food– Allergic reactions to foods usually begin

within minutes to a few hours after eating them

• Foods that cause delayed reactions are more difficult

15



– Food allergies• Most cases are relatively mild -- most

common symptoms– Swelling or itching of lips, mouth, and or

throat followed by– Nausea, vomiting, diarrhea– Itching, hives, eczema and skin redness– Some people experience sneezing, runny nose,

shortness of breath or other breathing difficulties

16



• Anaphylaxis is a rare but potentially fatal condition in which several parts of the body experience a food allergy reaction at the same time

– Symptoms may progress rapidly» Severe itching» Hives» Sweating» Swelling of the throat» Breathing difficulties» Lowered blood pressure» Unconsciousness» Death

17



18



• Once an allergy has been diagnosed, the only proven therapy is to avoid the offending food -- the prescription for a severe reaction is an injection of epinephrine (adrenaline)

• Children with allergies need all their nutrients, just as other children do

19



– Food allergies• Foods most often associated with allergies

– Nuts*– Eggs– Milk– Soybeans– Wheat– Peanuts*– Chicken– Fish*– Shellfish*– Mollusks (oysters, clams, snails, squid, octopi, etc.)*Are often outgrown

20


Nutrition for children and teenagers

• Early and middle childhood (con’t)– Hyperactivity and diet -- no

behavior problems originate with diet other than the general misery caused by malnutrition

21


• Early and middle childhood (con’t)– Caffeine and other stimulants

• Excess caffeine consumption can cause– Sleeplessness– Restlessness– Irregular heartbeats

• Caffeine found in– Cola beverages -- the effect of two 12 ounce beverages in a child is

equivalent to eight cups of coffee in an adult– Chocolate bars– Medication -- caffeine found in some

» Cold remedies» Diuretics» Pain relievers

• Pharmacologically active dose is 200mg

22


• Early and middle childhood (con’t)– Childhood obesity

• Increased dramatically over last three decades

• Diet and physical activity responsible• Influenced by television (and video games)

– Requires no energy beyond basal metabolism– Replaces vigorous activities– Encourages snacking– Promotes sedentary lifestyle

23



• Problems– Potential for becoming obese adults

» Social, economic & medical ramifications– Growth

» Typically grow taller than peers but stop growing at shorter height

» Develop greater bone and muscle mass -- both fat and lean weight (appear stocky even when they loose excess fat)

» Have a faster metabolic rate

24



• Problems– Physical health

» Display a blood lipid profile indicative that atherosclerosis is beginning to develop

» Tend to have high blood pressure» Increased risk for developing diabetes» Increased risk for developing respiratory diseases

(e.g. asthma)

25



• Problems– Psychological development

» Are often victims of prejudice

» Poor self-image

» Sense of failure

» Passive approach to life

26



• Prevention and treatment– Should be prevented or treatment begun early– Integrated approach is recommended

» Diet -- initial goal is to reduce the rate of weight gain» Physical activity» Psychological support -- parental involvement

encouraged» Behavioral changes -- focus on how to eat

27


• Early and middle childhood (con’t)

28


• Early and middle childhood (con’t)– Mealtimes with children

• Are a parent’s chance to influence food choices• Aims

– Avoid obesity– Encourage physical activity on a daily basis

• Vegetables– Children frequently dislike and refuse them– Do like raw vegetables over cooked ones-- offer them

slightly undercooked, colorful, warm (not hot) and mild– If they prepare (measure, stir, decorate, cut, or arrange)

them, they may be motivated to tray and taste them

29


• Early and middle childhood (con’t)– Mealtimes with children

• Snacks– Should provide foods as nutritious as meal times (can

be even mealtime foods served individually over time)

– Should be easy to prepare and readily available to children

• Sick days– On a short term basis, no reason to worry about loss

of appetite -- as children recover, so will their appetite– Encourage plenty of fluids

30


• Early and middle childhood (con’t)– Nutrition at school

• National school lunch program– Include specified numbers of servings of milk, protein-rich food

(meat, poultry, fish, cheese, eggs, legumes or peanut butter), vegetables, fruits, and grains

– Should provide 1/3 of DRI for each nutrient• National school breakfast program

– Available to about 40% of schools– Must contain

» One serving of fluid milk» One serving of fruit or vegetable or full strength juice» Two servings of bread or bread alternate or two servings of meat

alternate, or one of each

31


• Early and middle childhood (con’t)– Television and vending machines

• Many authorities concerned that television commercials have a negative impact

• Vending machines now available at schools

• Children will choose nutritious snacks when offered side by side with sugary foods

• When milk is available, soft drink use drops

32


• The teen years– Growth and nutrient needs

• Growth rate speeds up abruptly and dramatically with the onset of adolescence

• Lasts about 2 years• Energy needs vary to a great extent, depending on

– Intensity of the growth spurt– Body size– Physical activity

• Boys have a greater energy need than girls– Experience a more intense growth spurt– Develop more lean body mass

33


• The teen years (con’t)– Calcium

» Calcium intakes decline as milk consumption decreases

» Low calcium intakes of adolescents are caused, in part, by their choices to replace milk with soft drinks

– Food choices and eating habits of teenagers• With increasing after-school, social, and job activities,

irregular eating habits result• Adults become “gatekeeper” providing access to only

nutritious, economical foods

34


• The teen years (con’t)– Drugs, Alcohol, Tobacco, and Nutrition

• Marijuana– Alters sense of taste

– Enhances enjoyment of eating, especially of sweets

– Prolonged use does not seem augment energy intake long enough to bring on weight gain

• Cocaine– Users experience loss of appetite

– Weight loss is a common side effect

– Craving for drug replaces hunger

– Rats, given unlimited access of cocaine, will choose drug over food until they die of starvation

35


• The teen years (con’t)• Effects of addictive drugs

– Money spent on drugs cannot be spent on food– During “high” times, interest in food is lost– Some drugs induce depression of appetite– Drug abusers’ lifestyles often lack regularity and routine that promote good

eating habits– Hepatitis, common in drug abusers, causes taste changes and loss of appetite– AIDS is a risk– Treatments and medications may alter nutrition status– Illegal drug users often become ill with infectious diseases which increases

needs for nutrients

36


Nutrition for children and teenagers• The teen years (con’t)

• Alcohol– Is an empty calorie beverage– Can displace needed nutrients from the diet– Can alter metabolism and absorption of

nutrients received

37


• The teen years (con’t)• Cigarette smoking

– Risk of lung cancer is greater for smokers who have lowest intakes of carotene (Vitamin A)

– Smoking eases the feelings of hunger -- postpones energy and nutrient intake

» Smokers tend to weigh less» Smokers tend to gain weight upon cessation

– Smokers tend to have lower intakes of dietary fiber, Vitamin A, folate, and Vitamin C

» Vitamin C requirements of smokers may be twice as high as non-smokers

38

NUTRITION THROUGH THE LIFE CYCLENutrition For Older Adults

39


Nutrition For Older Adults

• Aging and NutritionPercent U.S. Population Growth 1960 - 1990

39

13

89

231

0

50

100

150

200

250

All agesUnder 25Over 65Over 85

40



• Life expectancy has doubled in the past century

• Aging seems to be inevitable– Programmed into the

genes at conception– Changing lifestyle habits

(regular physical activity) can slow the process within the natural limits set by heredity

41


• Good nutrition can retard and ease the aging process– Appropriate energy intake helps prevent

• Diabetes• Obesity• Related cardiovascular disease

– Adequate intakes of essential nutrients prevents diseases such as scurvy, goiter, anemia, and the like

42


– Variety in food intake as well as ample intakes of certain vegetables may be protective against certain types of cancers• A high fat diet is thought to promote cancer• Fiber and certain plant foods may help protect against

cancer– Less frequent use of vegetables is found in people with colon

cancer, specifically cabbage, broccoli, and Brussels Sprouts– Stomach cancer correlates with low vegetable intake– Lung cancer incidents can be as much as 60-80 percent lower in

people with high Vitamin A intakes than those with low intakes

43


Nutrition For Older Adults– Appropriate fiber intakes help prevent

malfunctions of the digestive tract such as constipation, diverticulosis, and possibly colon cancer

– Moderate sodium and adequate intakes of potassium, calcium and other minerals help prevent hypertension, at least to people who are genetically predisposed to it

– Adequate calcium intakes throughout life helps protect people against osteoporosis

44


Nutrition For Older Adults– Oral health issues

• Moderation in sugar helps prevent dental caries

• 50% of those over 65 have some form of dental or periodontal disease

• Medicare/Medicaid will not pay for dentures when treatment is pulling all the teeth

• Dental or gum issues should be identified (are under-assessed)

45


Nutrition For Older Adults– Oral health issues (con’t)

• Poor oral hygiene can result in– Avoidable weight loss

– Increase in fasting blood sugar

– Pneumonia

– Endocarditis

• Post CVA -- assess denture fit due to changes in facial muscle tone

46


– Oral health issues (con’t)• Things to watch out for

– Broken or loose teeth– Infected gums

» Showing bright inflammation» Changes in color of tongue» Long-term build-up of plaque

– Mouth pain– Sensitivity to foods (hot/cold)– Mouth sores/ulcers– Food pocketing in cheeks and under tongue– Check for denture fit -- poor fit contributes to not eating or chewing

well– Be alert to client who suddenly no longer performs self oral care --

could be the first signs of depression

47


– Nutrition related concerns• Cataracts

– Antioxidant nutrients (Vitamins C & E, Selenium) may help reduce oxidative stress (which plays a role in cataract development)

– Overweight appears associated but its role is not identified

• Osteoarthritis -- overweight can increase pain when weight-bearing joints are stressed and irritated by having to carry excess poundage

• Rheumatoid arthritis -- possible link to diet through the immune system, the integrity of which depends on adequate nutrition

48


• Nutrient needs and nutrition status of older adults– Water

• Dehydration is a risk• Elderly may not notice thirst• Elderly may not pay attention to thirst• Even mild stresses such as fever or hot climate may precipitate

rapid dehydration in older adults• 6-8 glasses of water per day is recommended

– Energy• Energy needs decline with advancing age

– Lean body mass diminishes, lowering BMR– Physical activity is typically reduced

• When energy intake decreases, people need to be sure the foods they eat are nutrient-dense

49


• Nutrient needs and nutrition status of older adults (con’t)– Protein -- needs area about the same as those of younger

people– Carbohydrate

• Abundant protein needed to spare protein• Complex carbohydrates supply fiber and essential vitamins and minerals• High fiber foods alleviate constipation• NOTE: High fiber foods can be low in protein and energy -- elderly

people may need protein and energy

– Fat -- limit• Cut kcalories• Retard development of cancer, atherosclerosis and other degenerative

diseases

50


• Nutrient needs and nutrition status of older adults (con’t)– Vitamins

• Vitamin A– Is absorbed and stored more efficiently in

the aging GI tract and liver, although processing within the body slows slightly

–Current DRI makes no recommendation for lowered intakes

51



• Vitamin D– Deficiency is a significant problem among older

adults» Many drink little or no milk, the most significant

source» Skin’s capacity to synthesize Vitamin D is

reduced– DRI doubles at age 51 (from 5 g/d to 10 g/d) and

increases to 15 g/d for women over 70

52



• Vitamin B-12–An estimated 15 percent of the elderly

population is deficient in Vitamin B-12–Because of the devastation neurological

effects of Vitamin B-12 deficiency (degeneration of peripheral nerves leading to paralysis), adequate intake is imperative

53


• Nutrient needs and nutrition status of older adults (con’t)– Minerals

• Iron – Iron deficiency anemia still occurs

» Especially in those with low food intakes» Chronic blood loss from ulcers, hemorrhoids, or other

disease conditions» Poor iron absorption due to reduced stomach acid

secretion» Antacid use, which interferes with iron (and folate)

absorption» Use of medications that cause blood loss including

anticoagulants, aspirin, and other arthritis medications

54


• Nutrient needs and nutrition status of older adults (con’t)

–Zinc»Chronic malabsorption diseases such as

Crohn’s disease impair zinc absorption»Alcohol consumption and stresses such as

surgery and burns increase zinc excretion»Medications may impair zinc absorption or

increase excretion–Calcium

»Requirements have increased by 200 mg for adults over 50

»Protects against osteoporosis

55


• Nutrient needs and nutrition status of older adults (con’t)–Supplements

• Vitamin D and calcium supplements, when recommended by physician for osteoporosis may beneficial

• Iron supplements, when recommended by physician for anemia may be beneficial

• Money spent on supplements may be better spent on nutritious foods

• If diet contains less than 1,500 kcalories, vitamin/mineral supplementation is recommended

***** 56

NUTRITION THROUGH THE LIFE CYCLENutrition For Older

Adults• Nutrient needs and

nutrition status of older adults (con’t)–Effects of drugs on

nutrition• Most drugs interact with

one or more nutrients in several ways, resulting in greater than normal needs for these nutrients

***** 57


• Nutrient needs and nutrition status of older adults (con’t)–Effects of drugs on nutrition

• Most drugs interact with one or more nutrients in several ways, resulting in greater than normal needs for these nutrients

• Altered food intake–Can influence appetite–Can alter taste or smell–Can cause sores or irritation in the mouth–Can reduce the flow of saliva–Can induce nausea or vomiting

**** 58



• Altered nutrient absorption– Laxatives cause food to move through the intestine that many

vitamins do not have enough time to be absorbed– Mineral oil, used as a laxative, robs a person of fat-soluble

vitamins, most notably vitamin D; calcium is also lost this way• Altered drug absorption

– Tetracycline and calcium or tetracycline and iron, taken at the same time, bind to each other, reducing the absorption of both

– Some medications are better absorbed with foods than without them

*** 59



• Altered metabolism–Structural analogues

»Warfarin opposes clotting by interfering with Vitamin K’s action

»To be effective, warfarin’s dose must be large enough to counteract vitamin K from the diet

• Competing with each other for metabolic enzyme systems

–Aspirin competes with folate for its’ protein carrier, thus interfering with the body’s use of the vitamin

** 60



• Altering enzyme activity and contributing pharmacologically active substances

– MAO (monoamine oxidase) inhibitors used to treat certain forms of depression interacts with Tyramine (an amine formed from the amino acid tyrosine and found in red wines and cheeses)

» Blocks enzymatic action enabling the release of norepinephrine

» Results in severe hypertension and headaches

* 61



• Altered drug excretion– An acidic urine limits excretion of acidic drugs

like aspirin– Vitamin C can lower the pH of the urine, thus

keeping aspirin in the blood longer• Altered nutrient excretion

– Some diuretics alter the excretion of the minerals calcium, potassium, magnesium, and zinc

62


• Food choices and eating habits of older adults– Factors

• Food likes and dislikes• Living conditions -- older adults who live alone do not

make poorer food choices but do consume fewer kcalories

• Economic status• Medical conditions• Congregate meals (provided in a place such as a

community center) offer socialization opportunities as well as nutrition

63



1 dnt 200 nutrition for health sciences nutrition through the life cycle part 2

Documents

life cycle nutrition

life cycle slide

children teenagers

iron deficiency anemia

middle childhood growth

behavior iron deficiency

health sciences nutrition

child slide