San Jose State University



Chapter 16 & pp. 423-442, 137-141?Adult NutritionAdult focusShift from growth to maintenancePreserving healthMaintaining healthy weightPromoting future health and wellness/preventing or delaying chronic diseaseList 4 lifestyle factors:Key Nutrition ConceptsPoor nutrition and health progress slowly and may or may not be reversible.Diet and exercise are modifiable risk factors for many diseases.Typically nutrient intakes ≠ recommendations.Enjoy their foodFocused on sustaining mental and physical capacity. Prevent/delay chronic Dz.Definition of Adulthood Ages in adulthood for teaching purposes:Early adulthood - 20-39 yrsMidlife - 40 to 64 yrs“Sandwich” generation – the 50’sLater adulthood – 60-65 yrs10 leading causes of deathSocial determinants of healthWhat adults eat:Personal choiceWhere people: learn work playCommunity they live inPolicies & politicsPhysiological ChangesGrowing stops by the 20’sBone density stops in early 30’s, declines begin ~40 yoMuscular strength peaks around 25 to 30, then declinesChanges in amount & location of body fatDecline in:Muscle mass (“lean muscle mass”)Lean massFlexibility & dexterityBone massClimacteric changes= Point in life where crucial changes occurMenopause: female end of reproductive capacityAfter 30 yo, males decrease testosterone and muscle mass+ E balance -> wt gain. Shifts subcutaneous to visceral (intra-abdominal) adiposityGut MicrobiomePart of the immune systemGut-brain axisGut dysbiosis (imbalance protective/harmful bacteria) may be associated with:Changes in wtInsulin sensitivityGlucose metabolismDyslipidemiaOther cardio-metabolic and carcinogenic factorsContinuum of Nutritional HealthEstimating Energy NeedsIndirect calorimetryDoubly labeled waterMifflin-St. JeorDeveloped in 1990More accurate than Harris-BennidictMales: RMR = (10 x kg) + (6.25 x cm) – (5 x age) + 5Females: RMR = (10 x kg) + (6.25 x cm) – (5 x age) - 161 p. 408 “A pound of body weight is the equivalent of approximately 3,500 kcals.”Nutrient RecommendationsAcceptable macronutrient distribution ranges (AMDR)Fat 20-35% of caloriesCarbohydrate 45-65% of caloriesProtein 10-35% of caloriesRisk NutrientsFiberCalcium & Vitamin DVitamin A Vitamin ECholinePotassium & SodiumMagnesiumIronDietary Guidelines: ?translates nutrient issues into food choicesSet of dietary and lifestyle recommendationsBased on latest scientific informationDeveloped to promote health and prevent diseaseKey components of the U.S. system are the Dietary Guidelines for Americans and MyPlateSpecific food approachConsume fruits, vegetables and whole grainsSelect health-promoting fatsSelect fish, poultry and meat alternativesSelect more nutrient-dense foodsLimit sugar & sodiumGet regular physical activityBalance E in with E outTotal diet approachChoose nutrient-dense foodsDon’t eat too muchBeveragesChoose H2O: 3-5 x 12 oz/dLimit coffee and tea to 3-4 C/dDrink 2 x 8 oz milkIf fruit juice is consumed, limit to 4 oz/dAvoid sweetened beveragesPhysical ActivityCombined w/ health-promoting eating can combat:CAD & CVAT2DMHTNOsteoporosisColon & breast cancerBenefits inc: improved muscle strength, balance, endurance, physical & mental health, cognitive fx, manages wt, lowers BP, improves blood chol, improves sleep, improves self-esteem & self-efficacy, decreases depression & anxiety…Define:Physical activityExercisePhysical fitnessWellnessUnstructured physical activityStructured physical activityHealth-related Components of FitnessAerobic activityCardiorespiratory enduranceMuscular strengthMuscular enduranceFlexibilityBody compositionNewest addition: NeuromuscularPrinciples of exerciseOverloadProgressionSpecificityRecuperationIndividualityReversibilityOveruseAdaptationsAcute bout structured PAChronic structured PARecommendations:Walk the walkUnderstand barriers to participationBe empatheticWrite a prescriptionCardiorespiratoryStrengthFlexibilityIf moderate, don’t need a stress testLeading causes of death by age groupTopics include:Overweight & obesityCancerCardiovascular diseasesDiabetesMetabolic syndromeHIV/AIDS“Dieting Mentality” ? adiposity =Distribution of body fat > indication of metabolic health Waist circumference = riskVAT v. SCATAge, sex, and cultural differencesAssessment & InterventionAssessment: BMI & waist circumference; Diet, weight, dieting & health history; PA; lab work; nut knowledge; readiness to change.Hamwi formulaIntervention:Medical nutrition therapyCognitive behavioral therapyMedsBariatric surgeryCardiovascular DiseaseReview terms:CHD or CAD (“CVD” in 7th) (CVD/CVA)IschemiaAnginaCoronary occlusionMyocardial infarctArteriosclerosisAtherosclerosisCAD InterventionsSame as for strokeCardio-protective diet: predominantly plant-food dietFish 2x/wkLimit saltAppropriate fatsWeight loss if ovwtDaily PANot smokingPharmacotherapy + diet modsMetabolic Syndrome?Syndrome XSeen in ~20-30% of U.S. adultsMetabolic abnormalities that risk of CHD, stroke & T2DM including: VAT (large waist circumference) fasting blood glucose, TG (TAG), BP HDLDiabetes MellitusDefinition: fasting blood glucose ≥126 mg/dL Type 1 (~10-15% of cases)Pancreatic beta cells destroyed – autoimmune DzType 2HyperinsulinemiaDefective production of insulin and insulin resistanceMost common typePhysiological effectsShort TermHunger & thirstFatigue Urination Weight Blurred vision Infections Wound healingLong TermHeart diseaseHypertension Blindness Kidney failureStrokePoor circulationLoss of limbsInterventions for Diabetes blood glucose and glucose metabolismMedical nutrition therapy (MNT) & physical activityExchange lists/CHO counting/plate methodSelf-Monitored Blood Glucose/HA1CPhysical ActivityPharmacotherapyGestational DiabetesSeen in 2-12% of pregnant womenIncreases w/ obesity low fiber dietLeads to:Increased blood glucoseTriglyceridesFree fatty acids HTNSpontaneous abortion, stillbirth & congenital anomaliesGlucose Screening / DxScreen all at 1st prenatal visit for DM:Fasting > 95 mg/dLRandom plasma glucose level > 200 mg/dLSymptoms of hyperglycemiaTest at 24-28 weeks with 75 g, 2 hour OGTTNormal if < 92 fasting < 180 @ 1-hour < 153 @ 2-hours50 g non-fasting screenOral glucose tolerance test (OGTT)?Fasting + 75 g glucosegivenGestational diabetes Dx if :Overnight fast > 92 mg/dL1-hour after glucose load > 180 mg/dL2-hours after glucose load > 153 mg/dLTxNormalize blood glucose with:DietAssess current habitsIndividualize eating planMonitor wt gainF/u during and after pregnancyPhysical activity: 3 x /wk @ ~50-60% of VO2 maxMetformin &/or insulin prnEating PlanEstimate caloric needDesign meal patternWhole-grain breads & cereals, vegetables, fruits, & high-fiber foodsLimited simple sugars & juice CHO that do not greatly raise glucoseUnsaturated fatsThree regular meals & snacks ................
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