Addressing Nutritional Risks of Older Adults. Randall Gretebeck University of Wisconsin

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1 Addressing Nutritional Risks of Older Adults Randall Gretebeck University of Wisconsin

2 Outline Age related changes in physiology Protein Carbohydrates Fats Fiber Water Vitamins and minerals of concern Components of a high quality diet

3 Age Related Changes in Physiology that Influence Nutrient Requirements Change in Physiology Muscle mass (Sarcopenia) Impact on Nutrient requirement Need for calories Bone density Need for calcium, vitamin D Immune function Skin capacity for cholecalciferol synthesis Parathyroid hormone Need for vitamins B12, folic acid, calcium, iron, zinc Need for vitamin D Need for vitamin D

4 Age Related Changes in Physiology that Influence Nutrient Requirements Change in Physiology Calcium bioavailability Hepatic uptake of retinol Efficiency in use of pyridoxal Oxidative stress Homocystene Impact on Nutrient requirement Need for calcium, vitamin D Need for vitamin A Need for vitamin B6 Need for vitamins A, C, E Need for folate, B6, B12

5 Anorexia of Aging Changes in taste and smell Fewer taste buds, taste buds atrophy Sense for salt and sweet decline after 60 followed by bitter and sour Appetite-regulating peptides reduced Gastrointestinal hormones reduced Delayed gastric emptying Medications Comorbidities Dietary interventions (low-fat, low-salt diets)

6 Protein 10-20% of typical energy intake RDA =.8 g/kg for sedentary healthy adults Recommendation for older adults is g/kg Higher requirement despite decreased muscle mass suggests lower efficiency of utilization Protein-calorie malnutrition is a major problem among home-bound and institutionalized elderly

7 Tips for Increasing Protein High protein shakes with nonfat dry milk Puddings, custards, quiches Hearty soups and stews with meat and dried beans Cottage cheese, regular cheese Greek yogurt (higher protein) for dips, sauces, dressings grams will stimulate muscle growth

8 EGGS U.S. advisory health panel is going to remove warnings about dietary cholesterol, saying that there is no link to levels of blood cholesterol that cause disease. Lower in cost than most other animal sources of protein Single serving packaging makes them convenient to store and prepare Easy to chew for people with dental problem or dysphagia Perceived by older adults as part of traditional diet

9 Carbohydrates Bread Pasta Potatoes Rice Corn Primary energy source for the world Inexpensive, long shelf life when refined

10 Carbohydrate Over 40% of US adults aged > 60 years have insulin resistance syndrome. Patients with this syndrome are at increased risk for the development of cardiovascular disease (CVD), type 2 diabetes mellitus, and dementia, three of the most significant health problems among people >65 years of age.

11 Refined Carbohydrates White flour, sugar, white rice, peeled potatoes, high fructose corn syrup Stripped of germ, bran and fiber Digested quickly Cause spikes in blood glucose followed by insulin High insulin levels promotes fat and glucose storage Hunger returns relatively quickly

12 Whole Grains Barley, buckwheat, bulgur, millet, oats, quinoa, brown rice, rye, sorghum, spelt, triticale (rye-wheat cross) whole wheat etc. Reduced risk of: stroke 30-36%, diabetes 21-30%, heart disease 25-28%, Other health benefits Reduced risk of asthma Healthier carotid arteries Reduced inflammatory disease risk Lower risk of colorectal cancer Healthier blood pressure levels Less gum disease and tooth loss

13 Tips for increasing whole grains Make substitutions use half whole wheat flour in recipes Add bulgur or brown rice to bread stuffing Add whole grains to soups Use uncooked oats instead of bread for meat loaf Try new foods Grain salads like tabbouleh Risottos and pilafs with barley, bulgur, millet

14 Monounsaturated Fats (considered good fats) Olive oil, canola oil sunflower oil, peanut oil sesame oil, avocados, olives, nuts One unsaturated bond in the molecule Can help reduce LDL cholesterol and lower risk of heart disease and stroke Associated with the Mediterranean diet Good source of vitamin E

15 Polyunsaturated Fats (considered good fats) Soybean oil, corn oil, sunflower oil, fatty fish (salmon, mackerel, herring, trout) More than one unsaturated bond in the molecule Can help reduce LDL cholesterol and lower risk of heart disease and stroke Good source of some essential fatty acids

16 Omega-3 fatty acids (considered excellent fats) Seeds, walnuts, flaxseed oil, fish oils Polyunsaturated fatty acid with a double bond at the third carbon from the end Mammals are not able to make omega-3 fatty acids but they are essential Can help lower triglyceride levels Linked to reduced inflammation Linked to better mental health

17 Saturated fats (considered bad, but recently disputed) Beef, lamb, pork, poultry with skin, cream, butter, cheese A study of almost 350,000 people concluded that there is no relationship between the intake of saturated fat and the incidence of heart disease or stroke Increases both good and bad cholesterol so ratio remains healthy Increases large buoyant LDL (good) not small dense LDL (bad)

18 Trans fat (very bad) Chemical process to make liquid oils more solid and stable Margarine, baked goods Largely disappearing from market place Produces small dense LDL particles that promote plaque formation

19 Fiber With age, intestinal motility slows, absorption of nutrients is reduced, and constipation is more frequent Fiber stimulates intestinal motility Fiber helps lower cholesterol Fiber helps modulate glucose (lower glycemic load)

20 Tips for increasing fiber Pick whole grain foods over refined carbohydrates Eat a wide variety of fruits and vegetables Choose high fiber breakfast cereals Aim for fresh fruit with meals Use more legumes (hummus, bean dip, salads soups etc) Go ethnic; Mexican, Middle Eastern and Mediterranean dishes tend to be high in fiber

21 Risk of dehydration With age Ability to conserve water is reduced Sense of thirst less acute Less able to respond to changes in temperature Lower water intake from food Diuretic medications Polyuria associated with prediabetes or undiagnosed diabetes

22 Tips for staying hydrated DRINK BEFORE YOUR THIRSTY!!!!!!!!!!!!!!!!!!!!! Keep beverages nearby, pre-poured in unbreakable containers that are easy to hold. Enjoy foods high in liquids, soups, stews, etc. Fruits and vegetables have a high water content. Remember: THIRST IS NOT A RELIABLE MEASURE OF HYDRATION!!!!!!!!!!!!!!!!!!!

23 Vitamin D Older people get less sun Borderline deficiency rates for older adults range from 38% in the fall to 60% in the early spring Skin of older people less effective at making cholecalciferol Older people drink less milk (fortified with vitamin D) Deficiency associated with muscle weakness and falls Vitamin D insufficiency is rarely treated in nursing homes despite strong clinical evidence and recommendations for supplementation

24 Tips for increasing vitamin D Older patients should receive sufficient vitamin D intake from all sources to lower their risk for falls and fractures, according the American Geriatrics Society. Dietary sources, sunlight, and supplements can all contribute to vitamin D levels of around 30 ng/ml (75 nmol/l), which appears to protect against fall-related injuries. Ask to have it measured at your next check up!

25 Calcium With age Reduced capacity to absorb calcium resulting from loss of vitamin D receptors in gut Increased prevalence of lactose intolerance Increased fiber for laxation impairs calcium bioavailability To increase calcium Increase dairy, fortified cereals Supplements 1,000-1,700 mg/d shown to be effective

26 B vitamins Riboflavin, B6, Folate, B12 Intake is generally low (below RDA) in older populations Evidence for increased requirement for B6 Strong evidence for reduced absorption of B12 (especially in Scandinavians) Elevated homocysteine (risk factor for vascular disease) is found in 30% of elderly and associated with low folate, B12, and B6, and can be reversed with folate and/or B12 supplementation

27 DASH DIET Dietary Approach to Stop Hypertension Recommended by USDA as the ideal eating pattern for all adults Encourages the high intake of whole grain, fruits, vegetables, and low-fat dairy products High in fiber, antioxidant components, and unsaturated fatty acids Lower glucose and insulin swings

28 DASH DIET Fruits -4 servings (2 cups) daily Vegetables -4 servings (2 cups) daily Low fat milk and dairy -2-3 servings (2-3 cups) daily Whole grains -3 servings (6 oz) daily Lean meat, fish poultry -2-3 servings (3-6 oz) daily Nuts, seeds, legumes -3-4 times weekly Oils 2 tsp Sweets, salt, alcohol - sparingly

29 Mediterranean Diet

30 Supplements? National Institute on Aging suggests: If you don t think you are making the best food choices, look for a supplement sold as a complete vitamin and mineral supplement Avoid mega doses Vitamin D -600 IU (International Units) for people age 51 to 70 and 800 IU for those over 70, but not more than 4,000 IU each day Calcium -Women over 50 need 1,200 mg each day, and men need 1,000 mg between age 51 and 70 and 1,200 mg after 70, but not more than 2,000 mg a day. Vitamin B mg for men and 1.5 mg for women each day Vitamin B mcg (micrograms) each day (get tested)

31 Questions?

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