COPC - University of Arizona



“Doctor: What Should I Eat?”

SBS – Fall 2005

Mary Marian, MS, RD

1) Discuss the barriers to obtaining a healthy diet for adolescents:

a) Healthy – not worried about adult diseases

b) Time, peer pressure, self-esteem, body image

c) Food preferences

d) Less parental involvement; > independence; irregular meals

e) Purchasing power – able to purchase more foods on own

f) Fast foods and the media

g) Lack of knowledge regarding healthy food choices

2) Discuss the deficits and excesses common in the adolescent diet:

a) Excesses:

• Fat:

o Total fat – 36% of girls and 30% of boys fall within the recommended guidelines for total fat intake

o Saturated fat – 34% of girls and 27% of boys fall within guidelines

• Calories, simple sugars, fat – associated with increased risk/incidence of obesity

• Protein, sodium, soda, caffeine – associated with increase loss of calcium ( risk for osteoporosis

• Sodium:

o Average intake 4000-5000 mg/d boys; 3000 mg/d girls

b) Deficits:

• Minerals

o Calcium: requirements increase @ age 11 from 1000 mg/d to 1300 mg/d

o From 1974 – 1995: Milk intakes 1/3 < and soda intake >50%

o Girls consuming diet sodas consume 20% calcium/day than non-soda consumers

o NHANES III data: calcium intake for girls 12-15 y.o. = 796 mg/d; girls 16-19 y.o. = 822 mg/d; 19% of girls and 52% of boys met calcium requirements

• Iron:

o Iron needs increase during adolescence during to expanding blood volume secondary to growth/menstruation; can be limiting factor for growth and immunity

o NHANES III: 14% of girls 15-18 y.o. and 12% of boys 11-14 with iron deficiency

• Vitamins

o Need for B vitamins (thiamin, folic acid, riboflavin, niacin, B6 and B12) increase related to increased energy demands

• Fruits and Vegetables

o 22% of boys and 23% of girls eat 2 or more servings/d of fruits; 38% of girls and 55% of boys eat at least 3 servings of vegetables/d

o Sector of population to have to lowest fruit/vegetable intake

• Fiber:

o Associated with decreased risk of obesity, CVD, and certain cancers

o Need to increase intake 25-50%

o age + 5 = recommended fiber intake

• Physical Activity

o 37% of students in grades 9-12 engaged in 20 minutes of vigorous physical activity 3 or more times/week; kids in P.E. classes – 33% report exercising 20 minutes or more in class 3-5 x/week

o Sedentary adolescences have a higher resting blood pressure than active

o Bone density also greater in active teens

3) Clinical issues

a) Obesity

• Obesity = BMI > 95th percentile, overweight = > 85th percentile

• 1 in 5 children in U.S. is overweight or obese

• Prevalence nearly doubled from 1976 to 1994

• Psychosocial consequences – poor body image and self-esteem, depression, disordered eating

• Contributed by excess energy intake and decreased energy expenditure

• Frustrating and difficult to treat; 25-50% remain overweight/obese as adults

b) Type 2 diabetes

• Had been rare in youth

• Three to tenfold increase in newly diagnosed cases

• Mean age 13.5 years; girls > boys

• Health implications tremendous

c) Disordered eating

• 10-20% of adolescent girls have anorexic or bulemic behaviors

• 50% of girls and 15% of boys have dieting behaviors

• Dieting habits: restriction, fasting, excessive exercise, diet pills or vomiting/laxatives

3) Discuss why consumption of a healthy diet is important:

a) Sets the stage of lifetime eating habits

b) Obesity increasing in children/adolescents

c) Performance improvement – academic, athletic

d) Disease already present in some

e) Some already require therapeutic diets for health

4) Counseling tips to promote consumption of a healthy diet:

a) Focus on performance improvement (e.g.: sports, academics)

b) Body image – promote healthy weight

c) Counsel in non-authoritative voice

d) Increase nutrition knowledge but minimize nutrition recommendations to most important:

□ focus on most common deficiencies in diet – especially, calcium, iron, and folate; may need to consider multi-vitamin/mineral supplementation;

□ encourage ideal fruit/vegetable intake (5/day) and > dairy; or low glycemic diet

□ encourage daily physical activity

e) Involve parents

5) Federal and State Food Assistance Programs

a) National School Lunch program (USDA)

□ Federal cash reimbursement and donated foods from the Commodity Food Program provided to schools

b) Special Milk program (USDA)

c) School Breakfast program (USDA)

d) Summer Food Service Program (USDA)

e) WIC Program (USDA)

f) Head Start Program (USDA) – kids 3-5 of families meeting federal poverty guidelines

g) Food Stamp Program

Adulthood

1) Discuss stages of adulthood:

a) Early adulthood: 20-39 y.o.

b) Middle adulthood: 40-65 y.o.

c) Older Americans: >65 y.o.

2) Discuss the barriers to adults consuming a healthy diet:

a) Unhealthy lifestyle habits may be already established

b) Time, stress, finances, lack of knowledge, food preferences, not worried about health

3) Discuss the benefits to consuming a healthy diet:

a) Optimize health and decrease risk for developing chronic diseases

b) Disease may already be present

4) Nutritional recommendations to focus on:

a) Goals 3 Fold: Maintain healthy weight, consume healthy diet; be physically active on most days (10,000 steps or aerobic/weight resistance training)

b) IOM recommendations for Macronutrients:

□ Carbohydrates, protein & fats

□ Micronutrients

c) Encourage healthy (Anti-inflammatory) diet:

□ 5/day – fruits/vegetables and adequate fiber (25-35 gms/d)

□ whole grains; avoid refined grains and sugars

□ Consume healthy fats: minimize intake of red meat and high fat dairy products; ( intake of processed foods (can be high in trans-fatty acids and omega-6 PUSFA); increase omega-3 fatty acid intake (fish 2 x/wk)

□ multi-vitamin/mineral supplement for woman of child-bearing age to ensure adequate folate intake; also assess adequacy of calcium intake

1) Community Resources:

□ American Heart Association, American Cancer Society, Dairy Council

Older Americans (>65 y.o.)

• Successful aging vs. unsuccessful aging

• Successful aging generally = adequately nourished; Unsuccessful aging may be = poor nutritional status, > frailty

1) Discuss the conditions associated with malnutrition in the elderly:

a) Psychosocial – depression, isolation, loneliness, loss of independence

b) Socioeconomic

c) Mental status changes – forgetfulness, dementia

d) Sensory losses, dentition/swallowing difficulties

e) “Anorexia of aging”

f) ( gastrointestinal function (digestion/absorption)

g) Alcoholism

h) Medications

i) Mobility

j) Lack of nutritional knowledge

k) Medical problems/poor health

2) Discuss the nutrient requirements for Older Americans:

a) ( energy needs: ( BMR, activity

b) ( proteins needs: ( from .8 gms/kg ( 1.0-1.2 gms/kg

□ may require adjustment based on clinical status

□ < protein with impaired renal and hepatic function

□ > protein for wound healing/decubiti

c) Micronutrients

□ At risk for deficiencies of calcium, zinc, vitamin B12, and D and other micronutrients with poor intake

□ HTN associated with abnormalities in calcium metabolism; diets high in protein and sodium increase calcium excretion

□ Consider use of daily multi-vitamin/mineral supplement (elderly absorb synthetic B12 > B12 from food sources)

□ BUT MANY OLDER AMERICANS TAKING LOTS OF DIETARY SUPPLEMENTS

d) Water/Fiber

□ Constipation frequent problem

e) Assess alcohol intake

3) Nutrition Screening/Assessment

a) Malnutrition less in individuals “successfully” aging vs. less “successfully” aging

b) Malnutrition more common in individuals with chronic diseases, institutionalized or experiencing frequent hospitalization

c) Nutrition Screening Initiative

□ National campaign to improve nutritional care for the elderly est. 1990

□ Established by the American Dietetics Association, Academy of Family Physicians, and the National Council on the Aging

□ Self-administered questionnaire to determine nutrition risk

4) Federal and State Food Assistance Programs

a) Same as above for adults; in addition:

b) Congregate Meals/Meals on Wheels

c) Commodity Supplemental Food Program

Nutrition Websites:

o American Dietetic Association:

o

o

o

o nhlbi.

o nal.fnic (food/supplement info)

o (evaluates benefits of nutrition websites; makes recommendations for the best)

o (fee)

Nutrition Newsletters:

o Nutrition Action

o Tufts

o Berkeley

o Harvard

o Consumer Reports

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