Nutrition Lifecycle (10/12)

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mse263
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252917
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Nutrition Lifecycle (10/12)
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2013-12-12 21:57:07
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Nutrition
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Final Exam
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  1. Lifecycle Nutrition - Pregnancy & Lactation
  2. How should a woman prepare before becoming pregnant?
    • because nutrition can affect her ability to actually become pregnant, she should:
    • 1. achieve/maintain a healthy body weight
    • 2. follow an adequate/balanced diet
    • 3. be physically active
    • 4. receive regular medical care
    • 5. manage chronic conditions
    • 6. avoid harmful influences
  3. How should a man prepare before trying to get a woman pregnant?
    • 1. achieve/maintain a healthy body weight: a higher BMI is correlated w/ low sperm count
    • 2. have adequate zinc, which plays a role in testosterone production & DNA (sperm) replication
    • 3. have enough antioxidants to keep sperm healthy (contain lots of PUFAs which can spoil easily but is prevented by antioxidants)
    • 4. minimize alcohol intake: lots of alcohol can lower sperm count
  4. What is the single best predictor of an infant's health?
    • its birthweight
    • women should NOT diet during pregnancy: may deprive fetus of critical nutrients
    • women must gain some but not too much weight during pregnancy; women who don't gain enough weight OR who gain too much put the baby at risk for health complications
  5. Weight Associated Risks
    • Underweight Moms have an increased risk of preterm births & infant death
    • Overweight Moms have an increased risk of complications DURING birth & health complications for infant after birth
  6. When is weight gain during a pregnancy most critical & why?
    • during the 2nd & 3rd trimester
    • brain development occurs in the last (3rd) trimester
  7. What were weight gain recommendations for women prior to 1970 & what was the reasoning behind such recommendations?
    • 10-14 lbs
    • a small amount of weight gain was recommended because it was noted that large weight increases were associated with preeclampsia
    • *this weight was actually coming from EDEMA
    • after 1970 the recommendation was increased to 20-25 lbs
  8. What weight gain recommendations did the Institute of Medicine (IOM) set for women in 1990?
    • they based weight gain on a womans weight (BMI) prior to pregnancy
    • those who weigh more should gain less
    • those who weigh less should gain more
    • the recommendation was DEVELOPED b/c of concern about low birth weight (LBW) infants
    • it aimed to PREVENT premature births & small for gestational age (SGA) infants
  9. Why did the IOM reexamine the weight during pregnancy guidelines in 2009?
    to include a new category addressing pre-pregnancy obesity
  10. IOM Pregnancy Weight Gain Guidelines
    • Underweight Women (<18.5) → gain 28-40 lbs
    • Normal weight Women (18.5-24.9) → 25-35 lbs
    • Overweight Women (25-29.9) → 15-25 lbs
    • Obese Women (>30) → 11-20 lbs
    • only ~1/3 of women stay within these ranges; vast majority gain more weight
  11. What happens to the Basal Metabolic Rate (BMR) during the 1st trimester of pregnancy?
    • it SLOWS DOWN, which is why weight gain isn't recommended until the 2nd & 3rd trimesters
    • all women except obese ones should gain ~4.4 pounds during the 1st trimester
    • WEEKLY weight gain changes in the 2nd & 3rd trimester: .5-1 lbs depending on BMI
  12. Where is the weight that's gained during pregnancy distributed?
    • 1. fetus: 25-27% (only 1/4 of the weight gain goes to baby)
    • 2. fat stores: 25-27%
    • 3. extra fluid: 13%
    • 4. uterus & breast growth: 11%
    • 5. expanded blood volume: 10%
    • 6. amniotic fluid: 6%
    • 7. placenta: 5%
  13. Critical Periods in Pregnancy
    • times of intense development & rapid cell division in the fetus
    • if cell division & development is compromised, it may be impossible for the baby to develop the structures & functions at all
    • oran & tissue development (esp during the 1st trimester) are the most vulnerable to adverse influences such as deficiencies, toxicities, or teratogens during critical periods
  14. Fetal Programming
    • or developmental plasticity: persisting changes in the body structure & function can be caused by environmental stimuli (especially NUTRITION)
    • genes can express different ranges of physiological or morphological states in response to environmental conditions during fetal development
    • explains how the groundwork for chronic diseases can originate if the fetus is exposed to adverse influences during critical periods of fetal development
    • such changes can potentially influence successive generations
  15. Dutch Famine/Hunger Winter
    • a famine in the German-occupied western part of the Netherlands during the winter of 1944-1945
    • a German blockade cut off food & fuel shipments to punish the Dutch for not aiding Nazi war efforts
  16. Famine Exposure during EARLY Gestation
    • birth weights were normal (DIDN'T decrease)
    • offspring had elevated rates of obesity, altered lipid profiles, & cardiovascular disease
    • females born to mothers during this time who went on to give birth had babies with LOW birth weights
  17. Famine Exposure during LATE Gestation
    • babies had low birth weights & continued to be small people throughout their lives
    • had lower rates of obesity as adults
    • females born to mothers during this time who went on to give birth had babies with NORMAL birth weights
    • *don't see the same tie to chronic disease as observed with early exposure to starvation
  18. When are energy & nutrient needs generally highest during the lifecycle?
    • during LACTATION & PREGNANCY needs tend to be higher than any other time in ADULT life
    • order: lactation > pregnancy > infancy
    • BMR increases during the 2nd & 3rd trimester after slowing down in the 1st
    • food intake should increase by ~15-20% during pregnancy
  19. What are the calorie modifications for each trimester of pregnancy?
    • 1st: NO extra calories (or a few)
    • 2nd: 340 more kcals/day
    • 3rd: 450 kcals/day
  20. What is the RDA for protein during pregnancy?
    an additional 25 g/day
  21. Fluid Intake During Pregnancy
    • fluid needs RISE to 3 Liters/day to help increase maternal blood volume, regulate body temperature, produce amniotic fluid to protect the fetus, combat constipation, & reduce risk of UTIs
    • + dehydration is a large cause of premature labor
  22. Neural Tube
    • embryo's precursor to the CNS (brain & spinal cord)
    • it closes by 18-26 days after conception
    • defects (NTD) such as anencephaly or spinal bifida are caused by failure of the tube to close or failure for it to close completely
  23. What role does folate intake & supplementation play in pregnancy?
    • supplementation of 400-600 micrograms/day & intake of 200-300 micrograms/day during the PERICONCEPTUAL period reduces risk of NTD
    • there is an increased need in pregnancy due to erythropoiesis (process by which RBCs are made)
    • was added to cereal grains in 1998 & reduced NTD by 28% in the US & 46% in Canada
  24. spina bifida
    • failure of spinal chord to close
    • is characterized at birth by an opening in upper part of the spinal chord
  25. anencephaly
    absence or failure to develop a brain
  26. What two micronutrients are needed during pregnancy for fetal bone development?
    • 1. Calcium
    • 2. Vitamin D
  27. Calcium during pregnancy
    • the RDA of Ca2+ does NOT increase b/c maternal absorption of Ca2+ increases during pregnancy (more doesn't need to be consumed)
    • if required Ca2+ intake is not met, the fetus gets it at the expense of the mother's bones; the mother suffers bone loss
    • RDA: 1000-1300 mg/day
  28. Vitamin D during pregnancy
    • the RDA of vitamin D does NOT increase
    • RDA: 600 IU/day
    • a deficiency interferes w/ calcium metabolism
  29. What two micronutrients are needed during pregnancy for fetal blood production & cell growth?
    • 1. Iron
    • 2. Zinc
  30. Iron during pregnancy
    • the RDA of iron DOES go up to increase blood volume, fetal needs, & compensate for blood loss during delivery
    • even though maternal & baby absorption of iron also increases during pregnancy
    • RDA: 18-27 mg/day
  31. How long after being born does the maternal supply of iron last for an infant?
    • 6 months
    • after 6 months an iron source needs to be given to the baby because breast milk is low is iron
    • AAP recommends supplementing iron at 4 months for breastfed infants
    • a mother's iron stores are transferred to the fetus during the 3rd trimester
  32. Zinc during pregnancy
    • the RDA of zinc DOES increase to facilitate DNA, RNA, & protein synthesis and "cell development"
    • low levels increase absorption & excess can be toxic to the fetus
    • RDA: 8-11 mg/day
  33. What are low levels of zinc during pregnancy associated with?
    • 1. preeclampsia - pregnancy induced hypertension
    • 2. decreased cell mediated immunity (T cell immune responses)
  34. Iodine during pregnancy
    • the RDA of iodine increases - can be obtained from iodized salt
    • mental retardation due to cretinism is entirely preventable using iodine supplementation during pregnancy
    • mental retardation due to cretinism = single largest cause of mental retardation
  35. Cretinism
    a condition of severely stunted physical & mental growth due to untreated congenital deficiency of thyroid hormones (hypothyroidism) usually due to maternal hypothyroidism
  36. What micronutrients need to be increased DURING pregnancy?
    • IRON, Zinc, & Iodine
    • calcium, vitamin C, & vitamin D levels remain unchanged
  37. Vitamin A during pregnancy
    • megadoses/excess vitamin A leads to fetal malformation, especially in the central nervous system
    • prior to 7 WEEKS such excess (eg. acutane) would be most damaging
  38. Caffeine
    • intake during pregnancy increases the rate of miscarriage, fetal death, or limited fetal growth
    • should limit intake to one coffee or 2 sodas a day; no more than 200mg should be consumed
  39. What substances may pose risk to the fetus?
    • Vitamin A
    • Alcohol
    • Caffeine
    • Sugar Substitutes, especially saccharine (exception of diabetics)
  40. Alcohol during Pregnancy
    • a teratogen that crosses the placenta associated w/ various birth defects, delivery complications, sudden infant death syndrome, & increased risk of miscarriage
    • FAS (fetal alcohol syndrome): characteristics associated w/ prenatal exposure to high quantities of alcohol [developmental/learning disabilities + facial, limb, & heart malformations]
  41. What micronutrients should pregnant vegetarians be aware of? Vegans?
    • vegetarians: should take Iron supplement
    • vegans: vitamin B12, Iron, Ca2+, vitamin D
    • are able to meet most nutrient needs through diet only
  42. Vitamin B12 Deficiency in Infancy
    • a vitamin B12 deficiency during pregnancy can result in fetal spinal cord damage & psychomotor retardation
    • if deficiency is recognized providing vitamin B12 after birth can correct the damage, however preventing the deficiency is preferred
  43. Common Pregnancy Concerns
    • 1. Nausea: caused by hormone changes oftentimes more during 1st trimester
    • 2. Constipation & Hemorrhoids: related to slowing of digestion in GI tract (can treat w/ fluid and fiber)
    • 3. Heartburn: caused by fetus' physical presence pushing on internal organs
    • 4. Food Cravings/Aversions: caused by hormone changes
    • 5. Pica: nonfood cravings, often a side-effect of dietary anemia
  44. What foods should be avoided during pregnancy & why?
    • *pregnant women are essentially immunosuppressed so are at higher risk for getting food-born illnesses (eg. Listeria)
    • hot dogs or deli meat (unless STEAMING)
    • smoked seafood (unless FULLY COOKED)
    • meat spreads/pâté
    • unpasteurized milk & cheese (brie, feta, blue, mexican cheeses)
    • more common to tell pregnant woman what NOT to eat than what to eat (b/c of time)
  45. What high mercury foods should be AVOIDED during pregnancy?
    • Swordfish, Shark, King mackerel, White Canned Tuna, Tilefish (golden snapper or bass)
    • these fish are high mercury b/c they're large fish that consume OTHER fish, compounding their mercury content
    • it's okay to eat ~12 oz. a week of shrimp, salmon, pollock, catfish or ~6 oz. of LIGHT canned tuna (smaller fish)
  46. Lactation
    • production of breast milk suppressed by estrogen/progesterone until childbirth
    • oxytocin: responsible for milk "let-down"
    • prolactin: responsible for milk synthesis
    • colostrum: 1st milk produced right after birth [yellowish, thick, clear] high in PROTEIN, antibodies, vitamins, & minerals
  47. Lactation Summary
    • energy & protein needs are higher than in pregnancy for mother
    • iron & folate needs are lower during lactation than in pregnancy; other vitamin & mineral requirements stay ~same
    • lots of water intake is required
    • alcohol, drugs, smoking, excess caffeine should all be avoided while breastfeeding
  48. Iron Needs Throughout Female Lifecycle
    • normal → pregnancy → lactation
    • 11mg 18-27 mg 8mg
    • iron needs decrease during lactation because woman isn't menstruating
  49. How many kcals/day does milk production require? How many extra kcals/day are lactating women RECOMMENDED to consume during lactation?
    breast milk production takes 700-800 kcals/day but women are only recommended to consume an extra 300-400 kcals/day (depending on how long after they've given birth) to help facilitate weight loss after pregnancy
  50. Benefits of Breastfeeding for Infant
    • it's nutritionally superior to formula
    • is always sterile & fresh
    • contains immunoglobins
    • is more digestible
    • reduces the risk of respiratory, GI, & ear infections
    • reduces the likelihood of overfeeding (infant controlled process)
    • promotes mouth/jaw development
    • provides omega-3 FAs
    • reduces the risk of SIDS, diabetes mellitus (DM), food allergies, & asthma
  51. Benefits of Breastfeeding for Mother
    • enhances recovery of uterus size
    • decreases post partum bleeding (conserving iron stores)
    • it's more convenient/economical (free!)
    • triggers hormones that help return internal organs to original state
    • decreases the risk of breast + ovarian cancer
    • delays ovulation (natural BC)
    • increases E expenditure facilitating weight loss
  52. contraindication
    specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the patient
  53. Contraindications to Breastfeeding
    • HIV (in the US but not 3rd world countries w/ poor water supply; it can be passed through breast milk)
    • Metabolism Issues/Allergies in Child (eg. galactosemia is a component in breast milk; if child can't metabolize or is allergic a special formula needs to be given)
    • Lifestyle Practices (alcohol, drugs, smoking, environmental contaminants, caffeine)
  54. How long should infants EXCLUSIVELY breastfeed? Breastfeed in general?
    • infants should exclusively breastfeed for 6 months
    • infants should be breastfed for at least 12 months
  55. *What happens to breast milk if a lactating mother has poor nutrition or intake?
    • the QUANTITY of breast milk is reduced, NEVER the quality of the milk (her body just won't produce enough)
    • the body will never make poor quality breast milk
  56. Breast Milk
    • has 20 cal/oz.
    • contains more whey than casein (70:30) b/c whey is more easily digested
    • composition of milk changes DURING a feeding
    • 1st = foremilk: sweeter, higher in lactose
    • 2nd = hindmilk: designed to satiate the infant, hold them over until next feeding
    • the milk is not a good source of iron but contains a small amount, the absorption of which is facilitated by lactose & vitamin C
  57. What are common problems associated with breast feeding?
    sore nipples, letdown failure, overactive letdown, engorgement, plugged duct, mastitis
  58. What are some components of formula feeding?
    • infants are MORE LIKELY to be overfed w/ formula
    • need to make sure it's safely prepared
    • it's easier to tell how much the infant is getting
    • the father (pshh) can be more involved
    • may require fewer feedings (takes longer to digest)
    • can iNTERFERE with breastfeeding (nipple confusion)
  59. Lifecycle Nutrition - Infancy, Childhood, Adolescence
  60. What are the most reliable markers of infants health status 1. after birth & 2. during infancy?
    • after birth: birth WEIGHT
    • during infancy: growth (& development) - way to measure if a child is well-nourished & healthy
  61. What are the 2 main types of growth charts?
    • 1. WHO growth standards: used to monitor growth for infants & children ages 0-2
    • 2. CDC growth charts: used for children ages 2+
    • *growth charts are the primary tool in detecting changes in growth & normal development
    • 50th percentile is "normal"
  62. What do growth charts between birth & 36 months (3 years) measure?
    • height for age
    • weight for age
    • weight for height
    • head circumference for age
  63. What do growth charts between 2 & 20 years measure?
    • height for age
    • weight for age
    • BMI for age (*different from straight BMI)
  64. What information do growth charts provide when plotted correctly?
    • information about a child's growth pattern
    • gestational age, birth weight, parental stature, & nutritional status may influence growth patterns
  65. Why are we not concerned about an infant losing weight soon after birth?
    • because it's normal to drop weight after birth
    • it's usually associated with fluid shifts associated with the trauma of birth
    • should be regained in ~the 2 weeks after birth
  66. At what age will most children double their birth weight?
    • 4-6 months of age
    • triple their birth weight by 12 months
    • QUADRUPLE birth weight by 2 years!
    • weight is the 1st measure affected by inadequate nutrition
    • a drop to a lower percentile in weight is usually an indication of some disruption in the child's expected growth
  67. What is the most difficult measurement to obtain accurately in infants & small children?
    HEIGHT
  68. What should happen to a child's height (length) by 12 months?
    • it should INCREASE by 50% percent
    • weight is affected before height
    • height will be maintained at the expense of weight
    • if height is affected/drops (stunting) that is indicative of a more long-term ailment
  69. Order of structures maintained during chronic poor nutrition
    • 1. brain circumference: will be maintained at all costs (LEAST sensitive)
    • 2. height: will go after weight has been compromised
    • 3. weight: the 1st characteristic affected by malnutrition (MOST sensitive)
    • *once head circumference for age once impacted will lead to irreversible poor developmental outcome
  70. Underweight [being small]
    • an abnormally low weight for age
    • can be caused by a recent illness or trauma (eg. rhodavirus)
    • once recovered can generally catch up
    • can also be caused by genetic or ethnic differences
  71. Wasting [becoming small]
    • an abnormally low weight for height
    • a child has a certain height but a low weight FOR that height
    • caused by acute, prolonged inadequate intake
    • wasting is correlated with mortality
  72. Stunting
    • an abnormally low height for age
    • but the weight for length value is normal
    • caused by chronic inadequate intake or genetic/ethnic differences
    • the child will be unable to reach a height they should have reached genetically
  73. How many kcals/kg/day do infants require?
    • 100 kcals/kg/day (compared to 25-35 kcals/kg/day for adults)
    • energy needs are extremely high for infants
    • protein: 2 kcals/kg/day (compared to .8 kcals/kg/day for adults)
    • fat: 40% of calories should be from fat (making CNS)
    • also have high fluid needs but that can come from breast milk/formula; exogenous water isn't required
  74. Is a multivitamin recommended for the 1st year of life? What is needed?
    • nope
    • Vitamin K injection given at birth to prevent hemorrhage & establish gut flora
    • Vitamin D supplementation should be given to breastfed infants (formula has it)
  75. When can solid foods be introduced to an infants diet?
    • ~4-6 months old
    • recommended 1st food = iron fortified rice, wheat, or barley
    • at this age an infant has increased digestive enzymes, loss of extrusion reflex, & increased musculature to sit upright
  76. What might occur if solid food is introduced before the infant is 4 months old?
    food allergies
  77. How should NEW foods be introduced to an infant?
    • ONE food at a time so that their reaction can be tracked
    • ~1 new food every 3 days
    • NO milk during the 1st year of life → GI bleeding
    • NO honey/corn syrup → increased botulism risk
    • introducing challenging textures improved oral-motor skills
  78. Baby Bottle Tooth Decay (Early Childhood Caries)
    • when babies/toddlers are allowed to have a bottle in their mouth for extended period of time, their teeth are bathed in the carbohydrate-rich formula or breast milk, causing tooth decay
    • sugar + oral bacteria → acid acid + teeth = decay
    • to prevent the bottle should be removed when the baby is done feeding
    • causes immature dentition, plaque filled mouth, low saliva, & contributes to childhood obesity
  79. Risks at Infancy
    • Colic (crying often tied with poor eating)
    • Iron deficiency anemia
    • Gastroesophageal reflux
    • Diarrhea (often due to juice, has a high osmotic load)
    • Failure to thrive
  80. Failure to Thrive (FTT)
    • infants & children who lose weight or fail to gain weight in accordance with standardized growth charts
    • inadequate physical growth
    • inability to maintain expected growth over time
    • often identified in the 1st 3 years of a child's life
  81. Organic Failure to Thrive
    refers to a child with an underlying medical condition that contributes to poor growth
  82. Non-organic Failure to Thrive
    refers to a child who is younger than 5 years of age and has no known medical condition that causes poor growth
  83. What is notably seen in a child's appetite at age 1?
    • a marked DECREASE in appetite
    • this is because their growth rate slows quite significantly
    • caretakers determine WHAT & WHEN children eat, but children decide IF & HOW MUCH they eat
  84. FITS (Feeding Infants & Toddlers Study)
    • a comprehensive survey conducted over the phone assessing food & nutrient intakes of over 3,000 infants & toddlers (up to age 3) by asking for a 24 hour diet recall
    • showed that fruit/vegetable intake was limited
    • older infants didn't get adequate iron & zinc
    • the UL for sodium was EXCEEDED
    • 80% of preschoolers (2-3 y/o) consumed nutrient poor energy dense drinks (soda/juice), desserts, & snacks dAILY
  85. Nutrient needs during childhood (ages 4+)
    • energy & protein needs DECREASE from those of infancy
    • getting micronutrients from regular food now - variety is necessary
  86. childhood growth chart interpretations
  87. How does childhood obesity affect growth?
    • obese children begin puberty earlier
    • they tend to be shorter than their peers
    • they have more bone & muscle mass
    • it's important to check their lipid profile, for type 2 diabetes, & respiratory disease
  88. What is the most effective way to deal with childhood obesity?
    • prevent it…
    • want to reduce their weight gain as opposed to have them lose weight
    • encourage physical activity (at least 1 hr. a day)
    • have their parents set a GOOD example
  89. SSB
    • sugar sweetened beverage; soda, juice, any drink that has calories
    • "the only drink with calories someone at risk for metabolic syndrome should be consuming is milk"
  90. Puberty (adolescence)
    • girls: 10-11 years old - gain ~6 in. in height, 35 lbs. in weight
    • boys: 12-13 years old - gain ~8 in. in height, 45 lbs. in weight
    • increase in calorie/protein needs after childhood
  91. Acne
    in adolescence mainly due to hormonal changes as opposed to food intake, which it's often incorrectly linked to
  92. Eating Disorders
    • red flag: vegetarianism for early teen girls; a socially acceptable way to restrict food intake
    • anorexia, bulimia (classic presentation is slightly overweight), binge eating (most common), & eating disorder NOS (not otherwise specified)
    • disordered eating: eg. disliking food touching on plate
  93. Female Athlete Triad
    • disordered eating (usually via a restricted diet) & inadequate intake of energy can lead to amenorrhea
    • loss of a period changes hormonal status
    • poor intake & no period can cause osteoporosis
    • end result: potential long-term poor bone status, short-term poor health status
  94. Lifecycle Nutrition - Older Adulthood
  95. What are some old-age related changes?
    • weight & body composition (add fat, lost lean mass, sarcopenia)
    • reduced muscle & skeletal strength
    • *FEWER calories are needed*
    • decline in immune defense mechanisms (can contribute to chronic inflammation)
    • decline in taste, smell, vision, mobility, hearing
    • loss of Ca2+ & decreased BONE density
    • decreased vitamin D synthesis (& intake)
    • reduced thirst response & dry mouth
    • Xerostomia - lack of saliva
    • Atrophic Gastritis
    • Reduced GI motility
  96. sarcopenia
    • age-related degenerative loss of skeletal muscle mass, quality, & strength
    • mediated by pro-inflammatory cytokines, growth hormone secretion, & input from a CNS that has fewer motor neurons
  97. What is the ideal diet for an older individual?
    • maximally nutrient dense but moderate in calories
    • percentages of CHO, fat, & protein stay the same but FIBER recommendations are lower b/c they're based on calorie needs (which are decreasing)
  98. How do micronutrient requirements for older adults change?
    • Ca2+ increases: it's less well absorbed (atrophic gastritis)
    • Vitamin D increases: needed for Ca2+ balance
    • Iron needs decrease: no longer monthly female losses
    • *Zinc should be adequate: maintain immune function & the senses
    • Vitamin A should stay the same
    • Vitamin B12 should be adequate
  99. How is vitamin B12 absorbed?
    • in food B12 is protein bound - must be separated in order for absorption to occur; this is done via 2 mechanisms in the stomach
    • 1. gastric acid
    • 2. protease enzymes (eg. pepsin)
    • *often older adults have less stomach acid, compromising B12 absorption
  100. Concerns of Mature Adults?
    • 1. drug-drug & drug-nutrient interactions
    • 2. depression
    • 3. anorexia of aging
    • 4. arthritis
    • 5. bowel & bladder regulation
    • 6. dental health
    • 7. osteoporosis
    • 8. Alzheimer's
  101. How does poor oral health affect nutritional status?
    • food is HARD to chew & swallow - soft foods are preferred leaving less variety available
    • overall can lead to a decreased desire & ability to eat
  102. What is a major risk factor for choking & malnutrition in old age?
    • Dentures
    • can't track food because tongue can't feel palate
    • false palate prevents sensing of food via tongue
  103. Age Related Macular Degeneration
    • a hole in the central part of vision
    • risk factors include age, smoking, & family history
    • may be reduced by antioxidants or lutein & zeaxanthin (can also reduce risk of cataracts)
    • if overweight lutein & zeaxanthin tend to deposit in body fat as opposed to macula where it can be protective
  104. What are the strongest independent predictors of macular pigment density?
    • 1. dietary lutein
    • 2. diabetes
    • 3. BMI
    • 4. waist to hip ratio
  105. How many older adults are malnourished?
    • 1 in 6
    • b/c of that there's a specific nutrition screening initiative called DETERMINE

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