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Nutrition for the Life Cycle

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Nutrition for the Life Cycle Jodene Imeson R.D., R.N. August 2010 Pressure Wounds Common Sites of Pressure Wounds Hip area (trochanter, ischial tuberosity) Heels ... – PowerPoint PPT presentation

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Title: Nutrition for the Life Cycle


1
Nutrition for the Life Cycle
  • Jodene Imeson R.D., R.N.
  • August 2010

2
Objectives
  • Describe guidelines for nutrient and energy needs
    during stages of the life cycle including
    infancy, childhood, adolescence, adulthood and
    geriatric periods.
  • State nutrition related areas of concern in each
    lifecycle stage.

3
Objectives
  • Describe the following nutrition related concern
    in each life cycle stage
  • Infancy
  • Breast vs. formula fed
  • Introducing solid foods
  • Food allergies and intolerance
  • Childhood
  • Establishing eating behaviors
  • Childhood obesity
  • Hyperactivity
  • Adolescence
  • Eating disorders
  • Substance abuse

4
Objectives
  • Describe the following nutrition related concern
    in each life cycle stage
  • Adulthood
  • Healthy habits
  • Metabolic syndrome
  • Geriatric
  • Drug - nutrient interactions
  • Pressure wounds

5
Infancy
6
Energy and Nutrient Needs
  • Energy Intake
  • Growth needs
  • Doubles wgt by 5 months (14-16 , 6-7 kg)
  • Triples wgt by 1 year (21 24, 9.5-11 kg)
  • Average wgt of 20-25 lbs by 1 year of age
  • Kcals 100/kg
  • Support rapid growth rate during 1st 6 months,
    then increased activity level in 2nd 6 months

7
Energy and Nutrient Needs
  • Nutrient Sources
  • CHO 60 of daily energy intake to feed the
    brain
  • 0 - 5 months - 60 gm/qd
  • 5 -12 months - 95 gm/qd
  • Fat supports rapid growth
  • 0 - 5 months - 31 gm/qd
  • 5 -12 months - 30 gm/qd
  • Protein basic building block of the body
  • 0 - 5 months - 1.52 gm/kg/qd (9.5 11 gm/qd)
  • 5 -12 months - 1.50 gm/kg/qd (14 17 gm/qd)

8
Energy and Nutrient Needs
  • Vitamins/Minerals
  • Need greater amounts than an adult, based on
    body size
  • Fat Soluble A4.5x, E2.5x, D10x
  • Water Soluble C4.5x
  • Minerals Calcium2x, Iodine7x
  • Water
  • Younger the infant the higher the of water wgt
  • Infants do NOT need supplemental water
  • 0 5 months 116 cc/kg (1.5 1.75 c/qd)
  • 5-12 months 88 cc/kg (3.3 3 c/qd)
  • Most water is in extracellular compartment
    dehydration occurs quickly (fever, vomiting,
    diarrhea)
  • Rehydrate with electrolyte solution designed for
    infants

9
Breast is Best
  • American Academy of Pediatrics and American
    Dietetic Association advocate breast feeding over
    formula feeding
  • High bioavailability of nutrients
  • Best nutrient composition
  • Immuno-protective
  • Promotes physiologic and cognitive development
  • Non allergenic
  • Sterile
  • Cost effective
  • Environmentally friendly

10
Breast Milk Natures Perfect Food
  • Energy Nutrients
  • CHO disaccharide lactose
  • Easily digested, enhances Ca2 absorption
  • Protein alpha-lactalbumin
  • Efficiently digested, absorbed
  • Lower protein content, less damage to kidneys
  • Fat Essential fatty acids (EFA)
  • Linoleic, Linolenic,
  • Non EFAs Arachadonic, Docosahexaenoic (DHA)
  • Being added to formulas

11
Breast Milk Natures Perfect Food
  • Vitamins/Minerals
  • Calcium content perfect for bone growth, well
    absorbed
  • Iron in small amounts but highly available
  • Supplements Needed
  • Vitamin K at birth to prevent hemorrhaging
  • Sterile intestine. Takes 6 months for bacteria
    producing Vitamin K to grow
  • Vitamin D from birth to 12 mos
  • Breast milk is low in Vit D content
  • Need 500 cc qd of Vit D fortified formula or a
    supplement

12
Breast Milk Natures Perfect Food
  • Vitamins/Minerals
  • Fluoride after 6 months
  • low content in breast milk and infants reserves
    are used up. If fluorinated water is used to
    prepare formulas and food, no supplement is
    needed
  • Iron after 6 months
  • RDA jumps from 0.27 mg/qd to 11 mg/qd at 6 mos

13
Breast Milk Natures Perfect Food
  • Colostrum antibodies, white blood cells
  • Protection from infections to which mom has
    developed immunity
  • Bifidus promotes growth of Lactobacillus
    bifidus
  • Keeps harmful bacteria in check
  • Lactoferrin iron binding protein
  • Helps prevent growth of harmful intestinal
    bacteria
  • Lactadherin protein that fights diarrhea-causing
    viruses
  • Growth Factor
  • Aides in development of infants digestive tract
  • Lipase helps fight infection

14
Formula Feeding
  • Formula standards set by the AAP reflect human
    milk from the 1st or 2nd month of lactation
  • FDA mandates safety, nutritional quality
  • Select the appropriate formula
  • Ask your pediatrician
  • Enfamil, Similac, Carnation, Parents Choice

15
Formula Feeding
  • Formula baselines
  • Cows milk majority of available formulas
  • Whey, caseinate protein
  • Iron fortified
  • Soy
  • Soy protein
  • Additives cornstarch, sucrose
  • Elemental

16
Formula Feeding
  • Risks of formula feeding
  • No protective antibodies
  • Formulas become contaminated leading to
    infection
  • Sterilize bottles
  • Sterile water
  • Refrigeration
  • Expiration dates
  • Cost

17
Advancing the Diet
18
Developmental Skills
  • Feeding Skill
  • Food to Add
  • 0 4 mos
  • Swallows using back of tongue
  • Strong extrusion reflex to push food out
  • 4 6 mos
  • Extrusion reflex decreases
  • Begins chewing action
  • Brings hand to mouth
  • Grasps with palm of hand
  • 6 8 mos
  • Able to feed finger food
  • Begins to drink from cup
  • Develops finger to thumb grasp
  • Breast Milk, infant formula
  • Iron fortified cereal
  • Puree vegetable and fruit
  • Textured vegetable, fruit
  • Diluted fruit juice in cup

19
Developmental Skills
  • Feeding Skill
  • Food to Add
  • 8 10 mos
  • Holds own bottle
  • Grabs spoon, fork
  • 10 -12 mos
  • Masters spoon with some spillage
  • Table cereals, bread
  • Yogurt
  • Soft cooked table vegetables and fruit
  • Begin finely cut meat, fish, casseroles, cheese,
    eggs
  • Progress to food pyramid suggested servings

20
Advancing the Diet
  • Cows milk
  • Nutrient content
  • High protein, calcium
  • Low iron, Vitamin C
  • Wait until at least 1 yr of age before
    introducing
  • May cause GI bleed and loss of iron
  • Higher protein content stresses infants kidneys
  • Whole milk (5 fat content) for first 2 yrs
  • Transition to 2 fat content between 2 - 5 yrs.

21
Introducing Solid Food
  • 4 6 months of age
  • Physically, metabolically able
  • Introduce foods with nutrients no longer
    available in breast milk, or reserve stores are
    depleted
  • Introduce one food at a time
  • Use small portions (2 - 3 tbs)
  • Wait 4 5 days before introducing another new
    food
  • Start with iron fortified cereals, then pureed
    vegetables and fruits
  • Avoid potential allergens
  • Wheat, cows milk

22
Introducing Solid Food
  • Nutrient considerations
  • Do NOT restrict Fat content in a child less than
    2 yrs of age
  • Toddler food labels cant provide fat levels -
    prevents attempts to restrict fat intake
  • Iron needs from food increase
  • Infant stores are depleted
  • Breast milk cant supply adequate amounts
  • Iron fortified cereals - poor bioavailability
  • add vitamin C source to aid Fe absorption

23
Introducing Solid Food
  • Nutrient considerations.
  • Limit fruit juice to 4-6 oz a day thru age 6 yrs
  • Must be diluted for infants 6 8 months
  • Serve from a cup, not in a bottle
  • Omit baby desserts and sweets
  • Sugar is an innate taste
  • Provide only empty calories
  • Promote obesity
  • Avoid Honey, Corn syrup
  • botulism

24
Introducing Solid Food
  • Choking Hazards
  • Hot dogs - Peanut Butter
  • Popcorn - Nuts
  • Grapes - Cherries
  • Hard or gel candies - Gum
  • Marshmallows
  • Raw celery, carrots

25
Mealtime with Toddlers
  • Provide nutritious foods and beverages in a safe,
    loving and secure environment

26
Mealtime with Toddlers
  • Dont allow unacceptable behavior. Be firm, not
    punitive
  • Throwing food, standing to eat
  • Use finger foods to allow exploring
  • Dont force foods
  • Need repeated experience to accept them
  • Allow choices from variety of nutritious foods
  • Limit sweets
  • Dont use food as a reward
  • Keep meal time pleasant

27
Food Allergies
  • Food allergy
  • 3 - 5 of children develop true allergy
  • occurs when large molecule proteins in the blood
    stimulate an immune response with creation of
    antibodies
  • Will be confirmed by antibody (Ab) testing
  • Symptoms may or may not occur
  • Immediate vs up to 24 hrs delayed reaction
  • Food intolerance

28
Food Allergies
  • Allergic reaction
  • Anaphylactic shock
  • Hives, rash, swelling
  • Difficulty breathing, asthma attack
  • Swelling of mouth, tongue, throat
  • Tingling sensation in mouth
  • Vomiting, GI cramps, diarrhea
  • Hypotension
  • Loss of consciousness
  • Death

29
Food Allergies
  • Most Common Food Allergens
  • Peanuts 1 risk for life threatening reactions
  • Tree nuts
  • Milk
  • Eggs
  • Soy
  • Wheat
  • Shellfish, fish
  • cause most reactions in children
  • Food labels must state if contain allergy
    producing food

30
Food Intolerance
  • Symptoms occur but no antibodies are formed
  • Adverse Reactions
  • Hives
  • Wheezing, cough, bronchial irritation
  • Rapid heart rate
  • Stomachache, diarrhea, cramping
  • Headache
  • Other agents causing adverse reactions
  • Food chemicals MSG, red/yellow dye
  • Pesticides
  • Lactose
  • Sulfur
  • Psychological aversion

31
Childhood
32
Energy and Nutrient Needs
  • Energy Needs
  • Growth
  • Gains 2 - 3 inches in height per year
  • Gains 5 - 6 pounds per year
  • Increase in muscle and bone mass and density
  • Total calories/Kg needed declines with age
  • Growth Spurt intermingled with periods of
    little to no growth
  • Meal patterns will coincide with growth patterns

33
Energy and Nutrient Needs
  • Age
  • Kcal needs
  • 1 3 years
  • 4 8 years
  • 9 13 years
  • 85 kcals/kg 1000 kcal qd
  • Females 82 kcal/kg
  • Males 87 kcal/kg
  • 85 kcals/kg 1650-1750 kcals/kg
  • Females 82 kcal/kg
  • Males 87 kcal/kg
  • 60 kcals/kg 2000-2250
    kcals/kg
  • Females 56 kcal/kg
  • Males 63 kcal/kg

34
Energy and Nutrient Needs
  • Nutrient Sources
  • CHO brains need for CHO is constant with that
    of an adults brain after 1 year of age
  • 130 gms CHO qd
  • Fat no RDA established
  • 1 3 years 30 40 of total kcals
  • 4 13 years 25 35 of total kcals
  • Protein requirement decreases with age
  • 0 - 5 months 1.52 gm/kg/qd
  • 5 -12 months 1.50 gm/kg/qd

35
Energy and Nutrient Needs
  • Vitamins and Minerals
  • Well balanced diet doesnt require
    supplementation except for Vitamin D and fluoride
  • Vitamin D may be adequate with sunlight exposure
  • Fluorinated water supply meets the need
  • Iron deficiency
  • 1 nutrient deficiency in childhood
  • Offer iron fortified infant formulas and cereals
  • Critical time for brain growth and development
  • used to make neurotransmitters that regulate
    attention span and learning ability
  • 7-10 mg Fe qd

36
Developmental Skills
  • Age
  • Food Skill
  • 1 2 years
  • 3 years
  • 4 years
  • 5 years
  • Uses short handled spoon.
  • Feeds self
  • Lifts and drinks from cup
  • Spears food with fork
  • Feeds independently
  • Helps pour, mix, spread food
  • Uses all utensils
  • Helps mash, roll, peel foods
  • Helps measure, cut soft foods

37
Establishing Eating Behaviors
  • Children have increased influence on family food
    decisions. Parents have responsibility to teach
    good nutrition and consumer skills
  • Television commercials
  • Family eating out
  • Make choices with school lunches

38
Establishing Eating BehaviorsChildrens
Preferences
  • Raw vegs to cooked
  • Warm foods to hot
  • Mild flavors
  • Smooth textures
  • Familiar foods
  • Child sized table
  • Small portions
  • Geometric shapes
  • Silly names
  • Eating with friends

39
Establishing Eating Behaviors
  • Allow children to help plan meals and prepare
    foods
  • Offer new foods one at a time, in small portions,
    at the beginning of the meal when the child is
    hungriest
  • Let the child decide for themselves what food
    they want to select from the healthy foods
    presented to them. Do NOT force unfamiliar foods
  • Power struggles over food sets up resistance and
    closes a childs mind to eating

40
Establishing Eating Behaviors
  • Let the child choose what, how much and when to
    eat. They need to learn to listen to their
    internal satiety cues
  • Provide nutritious snacks and let the child
    choose for themselves what to eat
  • Snacks may consist of mealtime foods eaten at a
    time the child is ready to eat them
  • Limit but dont restrict access to high fat/sugar
    foods and favorite foods
  • If food is restricted the child will want it even
    more

41
Establishing Eating Behaviors
  • Play first, then eat
  • Child is more relaxed and hungry
  • Will be racing thru meal to get down to play
  • Brush and floss
  • Establish good dental care early in life
  • Monitor for choking
  • Children typically have silent choking

42
Childhood Obesity
43
Childhood Obesity
  • 1 of 3 US children are considered overweight or
    obese
  • Overweight
  • Greater than 95th percentile
  • Number of overweight children has more than
    doubled in 20 years
  • 15 of US children are at risk of becoming
    overweight
  • Greater than 85th percentile

44
Childhood Obesity
  • Body Mass Index (BMI) is used as a screening tool
    to plot percentile on standardized growth charts
  • BMI Formula lbs x 703
  • inches2
  • Does not account for muscle vs fat content,
    larger than average body frame sizes, varying
    growth rates

45
Childhood Obesity
  • Risk Factors
  • Diet loading up on fast foods, high fat and
    sugar snacks
  • Lack of exercise television, video games replace
    outdoor activities and burning of kcals
  • Family History
  • Parental obesity doubles the chance a child will
    become an obese adult
  • Non-obese children with non-obese parents have
    lt10 chance of becoming obese adults

46
Childhood Obesity
  • Risk Factors
  • Psychological factors coping mechanism for
    stress, emotions, boredom
  • Family Habits types of foods purchased, how
    meals/snacks are served in the home
  • Socioeconomic low income children are at greater
    risk of obesity
  • Medical genetic syndromes, endocrine disease,
    medications

47
Complications of Childhood Obesity
  • Physical Complications
  • Type II diabetes, insulin resistance
  • High cholesterol, abnormal lipid ratios
  • High blood pressure
  • Metabolic Syndrome
  • Asthma, shortness of breath
  • Sleep disorders
  • Early puberty and menstruation

48
Complications of Childhood Obesity
  • Psycho-Social factors
  • Low self esteem
  • Depression
  • Hopelessness
  • Flat affect
  • Socially withdrawn
  • Behavior and learning problems

49
Prevention of Childhood Obesity
50
Prevention of Childhood Obesity
  • Healthy Eating
  • Limit sweetened beverages
  • Regular soda, fruit juice
  • Provide healthy snacks
  • Fruits, raw vegetables, plain crackers and
    cookies
  • Do NOT limit all sweets and favorite snacks
  • Children will rebel and find ways to get these
    items
  • Limit the meals eaten outside the home
  • Avoid Fast Food. Use sit down restaurants with
    limited portions, heart healthy entrées
  • Eat together as a family
  • turn off the tv, video, computer, phones

51
Prevention of Childhood Obesity
  • Increase Physical Activity
  • Limit computers, video games, tv watching to 2
    hours a day
  • Dont snack while involved in sedentary
    activities
  • Keep electronic toys out of the bedroom
  • Emphasize physical activities, not exercise
  • Active free play games (hide-n-seek, bike riding,
    skateboarding, neighborhood park, family walks)
  • Bowling, swimming, organized sports teams

52
Prevention of Childhood Obesity
  • Psycho-Social Support
  • Dont focus on your childs weight concerns
  • Praise your childs efforts, no matter how small
    the change
  • Focus on positive, incremental goals
  • Dont reward or punish with food
  • Listen to your childs feelings and needs
  • Be patient
  • Set a good example of diet and exercise yourself

53
Nutrition in Behavioral Concerns
  • Sugar Lows Highs
  • Need CHO intake every 4 hours to maintain steady
    stream of glucose to power the brain and nervous
    system
  • School breakfast program
  • Nutritious mid-morning snack
  • Iron deficiency
  • Affects neurotransmitters regulating attention
    span, learning ability (serotonin)
  • Brain is sensitive to iron deficiency before
    blood anemia clinically appears

54
Nutrition in Behavioral Concerns
  • Types of ADHD (Attention Deficit Hyperactivity
    Disorder)
  • Combined Inattentive/Hyperactive/Impulsive
  • Hyperactive/Impulsive
  • Inattentive

55
Nutrition in Behavioral Concerns
  • Symptoms of ADHD
  • constant motion
  • squirm, fidget
  • dont listen
  • talk excessively
  • interrupt
  • cant play quietly
  • easily distracted
  • dont finish tasks

56
Nutrition in Behavioral Concerns
  • Hyperactivity
  • No studies consistently show evidence of dietary
    impact on hyperactive behavior
  • Diets too restrictive may lack vitamins and
    nutrients required for adequate growth
  • Recommend high protein, moderate complex CHO, low
    simple CHO

57
Nutrition in Behavioral Concerns
  • Possible Elimination Items
  • Artificial Food colorings
  • FDC Red 40 (allura red)
  • FDC Red 3 (erythrosine)
  • FDC Yellow 6 (sunset yellow)
  • FDC Yellow 5 (tartrazine) must be on food
    label
  • Beverages, candy, ice cream, custards
  • Food Additives
  • Aspartame sweetener
  • Monosodium Glutamate (MSG) flavor enhancer
  • Nitrites
  • Used to preserve color, enhance flavor, protect
    against bacterial growth

58
Nutrition in Behavioral Concerns
  • Possible Useful Supplements
  • General Multivitamin/Mineral
  • Omega 3 Fish Oil improved mental skills in 8-12
    yr olds
  • Salmon, albacore tuna, trout, mackerel
  • Zinc reduction in hyperactivity, impulsivity
  • Oysters, red meat, poultry, dairy, nuts, legumes

59
Nutrition in Behavioral Concerns
  • Children need regular patterns of sleep, meal
    times, activity/play times and consistency in
    care
  • Misbehavior may reflect inconsistent care
  • Provide loving, supportive environment

60
Adolescence
61
Energy and Nutrient Needs
  • Energy Needs
  • Greater nutrient needs than any other time in
    life except pregnancy/lactation
  • Growth Spurt
  • Females age 10-11 at start of puberty
  • Height 6 inches
  • Weight 35 pounds
  • Fat gains
  • Males age 12-13 at start of puberty
  • Height 8 inches
  • Weight 45 pounds
  • Muscle and bone gains

62
Energy and Nutrient Needs
  • Kcal
  • Females 44 kcals/kg
  • Males 51 kcals/kg
  • CHO
  • 130 g/qd
  • Protein
  • 0.85 g/kg
  • Fat
  • 25 35 of total kcal needs
  • Fluid
  • Females 2.3 liters
  • Males 3.3 liters

63
Energy and Nutrient Needs
  • Vitamins/Minerals
  • Vitamin D needed for intense bone growth
  • Absorption enhanced by hormone production and
    sunlight exposure
  • No additional supplementation needed
  • Calcium needed for intense bone growth
  • Need 4 servings from dairy group a day
  • Most teenagers are well below the Adequate Intake
    (AI)
  • Increased risk for osteoporosis in later years

64
Energy and Nutrient Needs
  • Vitamins/Minerals
  • Iron
  • Needs dependent on growth spurt and beginning of
    puberty
  • Females begin menstruation
  • Need 8-16 mgs/qd
  • Males develop increased lean body mass
  • Need 8-14 mgs/qd

65
Food Choices and Health Risks
  • Snacking
  • Comprises 1/4th of teenagers intake
  • High in sugar, fat, salt
  • Low in fiber, calcium, iron, Vits A/C/folate
  • Beverages
  • Soft Drinks
  • 3x increase in use of soft drinks
  • Higher sugar intake
  • Lowers calcium intake overall
  • Higher acid intake corrodes tooth enamel
  • Caffeine
  • Eating Out
  • 1/3rd of all meals are eaten outside the home
  • Fast Food
  • No fruit, vegetables, milk

66
Food Choices and Health Risks
  • Nutrition Needs
  • Education
  • In the home, at school
  • Nutritious lunch choices at school
  • Limit vending machine choices in school
  • Keep healthy snack foods available at home
  • Family meal times together

67
Nutritional Impact of Substance Abuse
  • General Concerns
  • Money used on drugs rather than food
  • Lifestyle of drug use does not promote healthy
    eating habits
  • Drugs impact appetite
  • Taste alterations
  • Depressant
  • Dont eat during highs
  • Munchies

68
Nutritional Impact of Substance Abuse
  • Marijuana
  • Cannabinoids regulate appetite, pain, memory
  • Munchies intense craving for sugary items
  • Ecstasy
  • Impacts serotonin appetite, sleep, body
    temperature, mood, memory
  • Weight loss
  • Cocaine
  • Elicits stress response
  • Crave cocaine rather than food
  • Weight loss
  • Eating disorders
  • Dehydration, electrolyte imbalance
  • Stroke, seizure, heart attack, death

69
Nutritional Impact of Substance Abuse
  • Tobacco
  • Decreases feelings of hunger
  • Maintains lower body weight
  • Lower intakes of Vit A, beta-carotene
  • Increased risk of cancers (lung)
  • Depletes body of Vit C
  • Need 35 mg/qd more intake (100 -110 mg/qd)
  • Smokeless tobacco
  • Higher risk of mouth and throat cancers
  • Stained teeth, bad breathe
  • Alteration in taste and smell
  • Destruction of tooth surfaces, gums, jawbones

70
Nutritional Impact of Substance Abuse
  • Alcohol
  • 7 kcals/gm no other nutrients provided
  • Interferes with metabolism
  • Protein energy malnutrition (PEM)
  • Diuretic can result in increased thirst
  • B vitamin deficiencies B6, thiamine, folate
  • Impacts digestive system function in general
  • Increased homocysteine heart disease
  • Impaired memory, poor muscle coordination, nerve
    damage
  • anemia
  • Depressant slows/inhibits activity of the brain
  • Narcotic used as an anesthetic to deaden pain

71
Eating Disorders
  • Anorexia nervosa
  • Characterized by (DSM-IV)
  • low body weight (lt 85 percent of expected weight)
  • intense fear of weight gain
  • inaccurate perception of body weight or shape
  • Amenorrhea for at least 3 menstrual cycles
  • mean age of onset - 17 years
  • 1 of American teenage girls

72
Eating Disorders
  • Bulemia
  • Characterized by (DSM-IV)
  • binge eating (cant stop or control what is
    being eaten)
  • compensatory activities
  • Purging activities Vomiting, diuretics,
    laxative abuse, enema
  • Non-purging activities Fasting, extreme exercise
  • binge eating and compensatory strategies occur at
    least 2x/wk for 3 months

73
Eating Disorders
  • Multifactorial etiology
  • Individual
  • Family
  • Biological
  • Psychological
  • Cultural
  • Development of body image
  • Comorbid disorders are common
  • Affective disorder
  • Anxiety disorder
  • Personality disorder
  • Substance abuse

74
Eating Disorders
  • Failure to accomplish the tasks of adolescence
  • Adapting to their adult body image
  • Unrealistic perceptions of body size
  • Failure to normalize eating and exercise patterns
  • Development of autonomy
  • Unrealistic expectations for themselves
  • Development of self esteem
  • Preoccupation with weight and food, reflecting
    dependence on social opinion and judgment

75
Eating Disorders
  • Intervention Strategies
  • Psychotherapy
  • Medical monitoring
  • Nutrition
  • Health education
  • Dental care

76
Eating Disorders
  • Strategies to combat eating disorders
  • Eat frequently, use healthy snacks
  • Dont skip meals, or diet
  • Dont allow hunger to dictate food choices
  • Eat at the table using utensils to control eating
  • Plan meals and snacks. Keep a food diary
  • Utilize the Food Guide Pyramid for
    amounts/portions of foods to eat daily
  • Consume adequate fluid
  • Establish a reasonable weight goal, allow
    reasonable time to reach that goal
  • Gain/Loss of 10 of body wgt in 6 months
  • Exercise 30 minutes a day

77
Adulthood
78
Healthy Habits
  • As much as 75 of a persons life expectancy is
    dependent on individual health related behaviors
  • Regular, adequate sleep
  • Regular, well balanced meals
  • Regular physical activity
  • Not smoking
  • No or moderate alcohol use
  • Maintain healthy body weight

79
Healthy Habits
  • Benefits of exercise
  • Flexibility
  • Endurance
  • Muscle strength
  • Balance
  • Improved mobility
  • Reduced chance of falls
  • Lower BP, lipid levels
  • Weight control

80
Metabolic Syndrome
  • Syndrome X or insulin resistant syndrome
  • Body is resistant to insulin leading to
    hyperinsulinism, which in turn leads to
  • Risk factors for Cardiovascular Disease
  • Hypertension
  • Hyperlipidemia
  • Diabetes

81
Metabolic Syndrome
  • Defined by 3 or more of the following criteria
    (Adult Treatment Panel III, National Cholesterol
    Education Program)
  • Waist circumference (apple shape)
  • gt40 inches in men (gt102 cm)
  • gt35 inches in women (gt 88 cm)
  • HDL Cholesterol
  • lt40 in men
  • lt50 in women
  • Triglycerides gt150 mg/dl (1.7 mmol/L)
  • Glucose gt110 mg/dl (6.1 mmol/L)
  • Blood pressure gt 130/85

82
Metabolic Syndrome
  • Additional co-morbidities
  • Excessive blood clotting
  • Fatty liver
  • Low grade inflammation
  • Uric acid increases
  • High C Reactive Protein (CRP)

83
Metabolic Syndrome
  • Underlying risk factors
  • Obesity
  • Physical inactivity
  • Diet high in fats
  • Major risk factors
  • Cigarette smoking
  • Hypertension
  • Family history of coronary heart disease

84
Metabolic Syndrome
  • LIFESTYLE CHANGE
  • Weight reduction to lt25 BMI
  • Weight loss of 7 - 10 in the first year
  • Low fat, low cholesterol diet
  • Low simple carbohydrate diet
  • More fresh fruits, vegetables, whole grains
  • Reduce sodium intake
  • Increase physical activity
  • Stop smoking

85
The Golden Years
86
Energy and Nutrient Needs
  • Nutrient Needs
  • Basal metabolic rate decreases 1-2 per decade
  • Calories must come from nutrient dense foods
  • Lean body mass decreases
  • Need High biological value (HBV) protein for
    immune system and to prevent muscle wasting
  • Total body water decreases
  • Leads to rapid dehydration
  • UTIs, pneumonia, confusion, pressure ulcers,

87
Energy and Nutrient Needs
  • Kcal
  • Females 25 kcals/kg
  • Males 30 kcals/kg
  • CHO
  • 130 g/qd
  • Protein
  • 0.8 g/kg
  • Fat
  • 20 35 of total kcal needs
  • Fluid
  • 30 cc/kg
  • Females 2.1 liters
  • Males 2.6 liters

88
Energy and Nutrient Needs
  • Vitamins/Minerals
  • Vitamin D 10 15 micrograms/qd
  • Limited exposure to sunlight
  • Reduced ability of aging skin to convert Vit D
  • Inability or kidneys to convert Vit D to active
    form
  • Calcium 1200 mg/qd
  • Dairy products
  • Ca2 fortified juices
  • Calcium supplements
  • Iron 8-10 mg/qd
  • Chronic blood loss from disease, medicine
  • Poor absorption from altered GI secretions

89
Drug-Nutrient Interactions
  • Drugs Alter Nutrient Absorption
  • Foods Alter Drug Absorption
  • Alter acidity of GI tract
  • Alter digestive juices
  • Bind to nutrients
  • Alter GI motility
  • Transport time thru GI system
  • Inactivate enzyme system
  • Damage mucosal cells
  • Alter acidity of GI tract
  • Alter digestive juices
  • Bind to drugs
  • Alter rate of drug absorption
  • Compete for absorption sites in the GI tract

90
Drug-Nutrient Interactions
  • Drugs Alter Food intake
  • Drugs Alter Nutrient Excretion
  • Impact appetite
  • Interfere with taste, smell
  • Induce nausea/vomiting
  • Change oral environment
  • Inflame the mouth
  • Irritate GI tract
  • Alter renal reabsorption
  • K, Na. Ca
  • Displace nutrients from protein carriers

91
Drug-Nutrient Interactions
  • Not Absorbed Well w/Food
  • Absorbed Better w/Food
  • Acetaminophen
  • Aspirin
  • Antibiotics
  • cillins, cycline Erythromycin
  • Atenolol, Captopril
  • Levodopa/Sinemet
  • Phenytoin/Dilantin
  • Rifampin, Isoniazid
  • HCTZ
  • Aldactone
  • Propanolol, Metoprolol
  • Carbamazepine/Tegretol
  • Diazepam/Valium
  • Lithium

92
Drug-Nutrient Interactions
  • Do not take with Caffeine
  • Antihypertensives
  • Antipsychotics/depressants/anxiety
  • Anticonvulsants
  • Antiulcer
  • Oral hypoglycemics, insulin
  • Diuretics
  • Sedatives/Stimulants

93
Drug-Nutrient Interactions Caffeine Content
  • Coffee, brewed (5 oz) 130 Coffee, instant (5
    oz) 75 Tea, Brewed (5 oz) 40 Tea, Iced
    (12 oz) 70
  • Colas (12 oz) 40
  • Mt Dew (12 oz) 52
  • Milk chocolate (1 oz) 6
  • Dark chocolate (1 oz) 20
  • Excedrin (1 tab) 65
  • Midol (1 tab ) 30
  • No Doz, Vivarin 100
  • Dexatrim (1 tab) 100

94
Pressure Wounds
  • Functions of Skin
  • Largest organ of the body
  • 1st line of defense
  • Touch, pain, pressure, temperature sensation
  • Assists in temperature regulation
  • Excretion of metabolic waste
  • Identification based on individual
    characteristics
  • Communication of emotions

95
Pressure Wounds
  • Skin Layers
  • Staging of Wounds
  • Epidermis outer layer
  • Thin but tough, no blood vessels
  • Dermis inner layer
  • Thick connective tissue/collagen
  • Supplies blood, oxygen, nerves
  • Subcutaneous adipose tissue
  • Fascia muscle, bone, tendon
  • Stage I intact skin
  • (Non-blanchable redness)
  • Stage II Partial thickness
  • Stage III Full thickness
  • Stage III
  • Stage IV

96
Pressure Wounds
  • Interruptions in skin integrity
  • Abrasions, lesions
  • Burns
  • Diabetic ulcers
  • Pressure ulcers
  • Venous stasis ulcers
  • Others
  • Sickle cell anemia ulcers
  • Arterial insufficiency ulcers

97
Pressure Wounds
  • Risk factors for Pressure Ulcers
  • Disease Process/State of Health
  • Nutrition/Hydration
  • Mobility/Activity
  • Incontinence
  • Level of consciousness
  • Medications

98
Pressure Wounds
  • Common Sites of Pressure Wounds
  • Hip area (trochanter, ischial tuberosity)
  • Heels (Malleolus, calcaneus)
  • Toes (metatarsals)
  • Spinal column (thoracic, lumbar, sacrum, coccyx)
  • Elbow (olecranon)
  • Scapula
  • Back of head (occipital area)
  • Lumbar spine, hips

99
Pressure Wounds
100
Pressure Wounds
  • Supplementation
  • Multivitamin/minerals
  • Vitamin C (controversial)500 mg qd x 14 days
  • Zinc (controversial) 220 mg x 14 days
  • Arginine 17 - 24.8 gms/qd
  • Glutamine 0.57 gm/kg

101
Nutrition for the Life Cycle
102
Resources
  • www.kidshealth.org Nemours Foundation
  • www.kidfood.org American Dietetic Assoc.
  • www.shapedown.com Weight loss tips for children
  • www.chadd.org Children Adults w/hyperactivity,
    ADD
  • http//fnic.nal.usda.gov/nal Food and Nutrition
    Information Center
  • http//www.nlm.nih.gov/medlineplus/ National
    Library of Medicine, National Institute of
    Health
  • www.npuap.org National Pressure Ulcer Advisory
    Panel
  • http//www.nal.usda.gov/fnic/foodcomp/Data
    USDA Nutrient Database

103
Throw Your Weight AroundDiet Exercise Plan
  • Climbing the ladder of success 750
  • Making mountains out of molehills 500
  • Running around in circles 350
  • Throwing your weight around 50-300
  • (depending on your wgt)
  • Wading through your work 300
  • Putting the cart before the horse 300
  • Pushing your luck 250
  • Eating Crow 225
  • Jumping on the bandwagon 200

104
Throw Your Weight AroundDiet Exercise Plan
  • Climbing the Walls 150
  • Jumping to conclusions 100
  • Dragging your heels 100
  • Pulling your hair out 100
  • Pulling out all the stops 75
  • Bending over backwards 75
  • Beating around the bush 75
  • Stirring up the pot 50
  • Tooting your own horn 50
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