Transcript Nutrition 101
Nutritional Care of Older Adults
Laurie B. Steenwyk M.Ed, RD, LDN
Class Overview
Assessing Nutritional Status Nutritional Needs of the Elderly Nutrition Interventions Eating Lifestyles Meal planning for optimal health
Assessing Nutritional Status
Factors Impacting Nutritional Status in the Elderly
Assessing Weight Status
BMI <23 considered underweight >65 yrs Percent Weight Loss (unintended) >5% in 1 month (quadruples risk of death) > 7.5% in 3 months >10% in 6 months Cachexia Severe wasting accompanying diseases such as cancer
Mini Nutrition Assessment
6 question screening tool Complete in <5 minutes Validated for age >65 More sensitive than BMI Available at: http://www.mna elderly.com/
Sarcopenia
Sarcopenia Loss of skeletal muscle associated with aging Affects 8-40% of adults >60 yrs 50% of adults >75 yrs Sarcopenic Obesity Coexisting loss of skeletal muscle mass and strength with excess body fat
Nutritional Needs of the Elderly
Energy
Energy (calorie) needs decrease with age, mostly due to decreased physical activity LBM declines with age and influences energy needs Protein and vitamin/mineral needs remain the same or increase Challenge: adequate micronutrients within caloric requirement
Nutrients of Concern
Risk for deficiency with age Water Fiber Protein Calcium and Vitamin D Vitamin B12 Vitamin C and E – antioxidants
Water
Dehydration is a form of malnutrition Kidneys’ decreased ability to concentrate urine Adverse effects of medication Mobility disorders Fear of incontinence 25-30 mL/kg actual body wt
Fiber
Fiber Goals for adults over 50: Men: 30 g per day Women: 21 g per day Insoluble: Tough, fibrous plant material that does NOT absorb water Most grains and vegetables Soluble: Plant fibers capable of absorbing water and become gummy or gel-like Oats, fruit, legumes, pectin, inulin, psyllium
Sources of Fiber
Oats Barley Wheat Quinoa Flax Brown Rice Bran Legumes Seeds Fruits Vegetables
Protein
Muscle mass (LBM) decreases 15% per decade after age 70 Needs increase with illness, injury Surgery, wounds, CHF, COPD, Cancer Optimal intake: 25-30 gm/meal Even distribution most effective in preventing muscle loss during illness 1-1.6 gm/kg IBW may prevent sarcopenia
PROTEIN Sources:
Animal Proteins Egg, Turkey, Fish, Beef… Dairy Milk, Cheese, Yogurt, Cottage Cheese… Legumes and Nuts Black Beans, Red Beans, Lentils, Walnuts… Some from grains/breads/plants Quinoa, Greens, Broccoli, Oats, Pasta…
Vitamin D
800 IU >70 years Safe upper limit 4000 IU Supplements are recommended for older adults Sources Fortified milk Fatty fish, fish oil Liver Egg yolk Some enriched beverages Exposure to sunshine during Spring, Summer, early Fall
Calcium
1000 mg Men <70 years 1200 mg Men >70 1200 mg Women >50 Safe upper limit 2000 mg/day A large recent study suggests that calcium supplements don’t prevent hip fractures
Calcium
Dairy Sources 1 cup milk – 300 mg 4 oz yogurt – 200 mg 1 oz cheese – 200 mg ½ cup cottage cheese – 65 mg ¼ cup ricotta cheese 200 mg -
Non-Dairy Calcium Sources
1 cup Calcium fortified orange or apple juice (240 mg) Enriched, GF almond, soy or rice milk – 300 mg 3 oz Sardines – 370 mg 3 oz Canned Salmon w/ bones – 180 mg Almonds ½ cup Broccoli (90 mg) 2 oz Tofu (made w/ calcium sulfate Firm Tofu (385 mg) Regular Tofu (200 mg) 1 T Blackstrap Molasses – 135 mg 1 T Tahini – 65 mg
Other Nutrients in Bone Health
Vitamin K Leafy greens, broccoli, soybean oil Manganese Spinach, peanuts, almonds, brown rice, green tea Excesses of sodium, protein and phosphorus decrease calcium availability.
Vitamin B-12
6-15% of older adults are deficient Another 20% have marginal status Compromised absorption Pernicious anemia Lack of intrinsic factor Atrophic gastritis Long-term use of PPIs
Vitamin B-12 Deficiency
Symptoms Folate Deficiency Numbness, tingling of arms, legs Difficulty walking Memory loss Disorientation Dementia Sore tongue Poor appetite Constipation Possibly depression Sources Meat Poultry Fish Dairy Products Supplement Recs: Adults 2.4 mcg/day >50 yrs should take supplement >65 yrs 100-400 mcg/day
Anti-Oxidants (C and E)
Vitamin C
RDI 75 mg females and 90 mg males 400 mg may be beneficial to older adults UL is 2,000 mg The role of anti oxidants in macular degeneration and dementia is unclear
Vitamin E
RDI: 15 mg for adults UL is 1000 mg Supplements can increase risk of bleeding in patients on anti-coagulant therapy Sources: oils, nuts, peanuts, avocado
Nutritional Interventions
Increasing Calories
5-6 small meals/between meal snacks Calorically dense foods Nut butters, dried fruits, fruit purees, starchy vegetables, legumes, cheese, yogurt Drink calories Milk, juice, smoothies, soups Increase fats butter, sour cream, cream cheese, oils, mayonnaise, avocado
Oral Nutrition Supplements
Use 1.5 -2.0 cal/mL Ensure Plus, Ensure Clinical Strength, TwoCal, Boost Plus, etc Serve 3-4 oz portions several times Use as a “med pass” Dilute with whole milk or serve frozen to reduce sweetness Encourage 1 sip every 5 minutes to reduce early satiety
Texture
Meats: chopped, ground, pureed Use puree molds or small colorful dishes Piping soft foods, garnish with sauce Cut hard fruits, vegetables into bite sized pieces Finger foods work well with dementia or severe arthritis
The Dining Experience
Buffet service, family style service Encourage selection Avoid social isolation Music Aroma Appearance and presentation
Home Meals
Financial limits Eggs, peanut butter, canned beans, tuna, turkey, frozen veggies, rice Limited cooking ability Weight Watchers, Healthy Choice, Kashi Meals Precut fruits and veggies Prepared soups, crackers, whole grain bread, bagels, quick oatmeal, cheese, yogurt, cottage cheese, frozen veggies, bananas, grapes, hummus
Appetite Stimulants
Limited evidence of effectiveness in the elderly Megace Remeron Eldertonic Marinol Periactin Oxandrin
Eating Lifestyles
The Mediterranean Diet The DASH Diet The New American Plate MyPlate for Older Adults
2009 Version
Fruits, Vegetables, grains, olive oil, beans, nuts and seeds are grouped together at the base Herbs and Spices are added at base Fish is promoted over poultry and dairy
Benefits
9% decrease in overall mortality 9% decrease in death from cardiovascular disease 6% decrease in death from cancer 13% decrease in incidence of Parkinson’s and Alzheimer’s Disease Safi, F. et al,
Adherence to Mediteranean Diet and Health Status: Meta-analysis
. British Journal of Medicine, 2008: 337:a1344.
Key Mediterranean Principles
Generous amounts of fruits and vegetables Healthy fats: olive oil Small portions of nuts Red wine in moderation, for some Very little red meat Fish on a regular basis
DASH Diet Pyramid
Dietary Approaches to Stop Hypertension
DASH Benefits
Reduces blood pressure, especially in older adults.
Also protective against Osteoporosis Cancer Heart Disease Heart Failure Stroke Diabetes
Key DASH Principles
Limits sodium to <2300 or <1500 mg/day Generous amounts of fruits & vegetables Whole Grains Emphasizes low fat dairy Monounsaturated Fats <27% of calories from fat Legumes, nuts or seeds daily Lean protein: fish, poultry, soy products High in calcium, potassium and magnesium
New American Plate Proportions:
2/3 plate should be plant based Whole grain Vegetables Fruit Legumes 1/3 from protein Fish Lean Beef Poultry Dairy
1/3
2007 Expert Report on Cancer Prevention
Joint effort of AICR and World Cancer Research Fund 7000 global scientific studies reviewed 10 lifestyle recommendations for cancer prevention
Diet Recommendations
Limit sugary drinks and energy dense foods Eat more of a variety of fruits, vegetables, grains, legumes Limit red meat and processed meats Limit salt and foods processed with sodium
MyPlate for Older Adults
MyPlate for Older Adults
Bright-colored vegetables such as carrots and broccoli.
Deep-colored fruit such as berries and peaches.
Whole, enriched and fortified grains and cereals such as brown rice and 100% whole wheat bread.
Low- and non-fat dairy products such as yogurt and low-lactose milk.
Dry beans and nuts, fish, poultry, lean meat and eggs.
Liquid vegetable oils, soft spreads low in saturated and trans fat, and spices to replace salt.
Fluids such as water and fat-free milk.
Physical activity such as walking, resistance training and light cleaning.
http://now.tufts.edu/news-releases/tufts-university nutrition-scientists-unveil-
Resources
Food & Nutrition Information Center http://fnic.nal.usda.gov/lifecycle nutrition/aging Tufts Human Nutrition Research Center on Aging http://hnrca.tufts.edu/
Resources
DASH Eating Plan Booklet, free on the web: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new _dash.pdf
Mayo Clinic http://www.mayoclinic.com
Use their search engine and type in “DASH Diet” or “Mediterranean Diet” to view numerous consumer friendly articles.
Oldways: Mediterranean diet info http://www.oldwayspt.org/med_pyramid.html
Resources
AICR: The New American Plate Printable brochures, Cookbook, recipes http://www.aicr.org/site/PageServer?pagename=reduce_diet_ new_american_plate Linus Pauling Institute micronutrient information center http://lpi.oregonstate.edu/infocenter/