Adolescent Nutrition Notes Part 2

6.aDescribe changes that occur during andropause ● Graduate decline in male hormones (testosterone) ○ Erectile dysfunction ○ Decreased sex drive ○ Loss of muscle mass ○ Anxiety and irritability ○ Sleep disturbance ○ Loss of bone density ○ Cardiovascular disease  7. Identify treatment for andropause. Name risks and benefits. ● Hormone therapy (testosterone) ○ Benefits ■ Improved sex drive ■ Improved muscle mass and strength ○ Risks ■ Prostate and breast enlargement ■ Erythrocytosis and stroke ■ Infertility  Chapter 18: Nutrition and Older Adults You should be able to: 1. Define sarcopenia, xerostomia, dysphagia, cataracts, glaucoma, macular degeneration, rheumatoid arthritis, osteoarthritis, lutein, zeaxanthinL ○ Muscle wasting ○ Progressive loss of muscle mass and strength ○ Process characterized by 3-8% reduction in lean muscle mass/decade >30 years ○ Affect 45% of individuals >65 years ○ 50% of those > 80 years  ● Xerostomia ○ Dry mouth from decreased saliva flow ○ Lack of saliva slows nutrient absorption → leads to oral cavities ○ Increase in bacteria = bad breath  ● Dysphagia ○ Difficulty swallowing ○ Risk factor for pneumonia if the liquid hits the lungs  ● ● ● ● ● ● Cataracts ○ Cloudy lens ○ By 80, more than ½ ○ Build proteins in the lens ○ Scatters ray of light ■ Decreased low light ● Dawn ● dusk  Glaucoma ○ Damage to the optic nerve ○ Can cause blindness if not treated ○ Increased eye pressure ■ Pressures your optic nerve ○ Starts with peripheral  Macular degeneration ○ Photoreceptors in retina atrophy ○ Damages and destroys ■ Central vision ○ Risk factors ■ Greater than 60 ■ Smoke ■ HTN ■ Obese ■ Female ■ Family history ○ Wet vs Dry ■ Dry = yellow deposits ■ Wet = abnormal blood vessel growth  Rheumatoid arthritis (autoimmune) ○ Joint destruction; deforming of joint ○ Can increase the risk of osteoarthritis  Osteoarthritis (degenerative) ○ Wear and tear of cartilages ○ Much more common ○ Occurs because of bone remodeling with age Lutein: carotenoids ○ Orange foods like carrots  ● Zeaxanthin ○ Carotenoids like green leafy vegetables 2. Compare the theories of aging. ● Programmed cell death ○ Hayflick’s theory of limited cell replication ■ Cells divide a finite number of times then die ■ It is difficult to prove because we die more often from age-associated chronic disease than from old age  ○ Molecular Clock theory ■ Based on loss of telomere on chromosomal DNA → you lose them you die ■ Telomeres that cap the ends of chromosomes act to mark time become shorter with each division ■ Loss of telomeres = stopping the ability of chromosomes to replicate new cells can’t form if old   ● Wear and tear ○ Accumulation of cellular damage through ■ Oxidative stress ● due to buildup of reactive (unstable) O2 compounds ■ Rate of living ● Higher metabolic rate and greater expenditure leads to greater turnover of all body tissues. ● Faster living = faster aging ● Living more slowly = longer life ○ Aging well video ○ Genetics, environment, lifestyle ■ Less physical stress ■ Less regular caloric intake  3.Discuss the following physiological changes for the older adult: body composition, senses, organ systems, skeletal, endocrine, immune ● Body composition/function ○ Fat-free mass decreases (2-3% per decade) ■ Muscle ● Sarcopenia 15% loss ● Bone ● Water ■ Body fat ● Increased fat stores ■ Weight changes ● Study of adults over 20 years ● Weight and BMI peak between 50-59 ○ 1.2 pounds/year women ○ 0.7 pounds/year men ● Senses ○ taste/smell ■ Generally good until 60, start to decline ● Taste buds and loss of olfactory nerve endings ○ Hearing ■ Impaired inner ear function ● Gastrointestinal ○ Oral ■ Xerostomia ■ Loss of teeth ■ Dysphagia ○ Stomach: decrease in stomach acid over time ■ Atrophic gastritis ○ Intestinal ■ Reduced absorption ■ Reduced mortality ● Skeletal system ○ Of all physiologic changes that occur during aging, the biggest effect on nutritional status and physical resilience is due to shifts in the musculoskeletal system ○ 2-3% loss per decade from age 30-70 → leads to loss of up to 15% of muscle mass (sarcopenia)  ● Endocrine system ○ Changes in hormone levels ● Immune system  4. Describe how to delay eye problems as a person ages. ● Diets high in antioxidants ○ Vitamin C ○ Vitamin E ○ Carotenoids (lutein/zeaxanthin) ■ Zinc (can cause GI upset) ● Protect your eyes  5. Explain nutrient needs for the older adult, highlighting nutrients of importance and why older adults are deficient in certain nutrients. ● Energy (overall decline) ● Macronutrients ○ Carbs: 130 g/day or 45-65% ○ Fat: 10-35% (AMDR) ■ Omega 3 and low saturated fat recommended ○ Protein: 10-35% (AMDR), need enough to spare ■ 8 g per kg of body weight ● Fiber ○ Slightly decreased because less energy is needed (30 g men, 21 g women) ● Fluids ○ DRI not increased ○ Should be adequate for bowel movement and hydration ○ People will try to decrease fluid intake because they become incontinent but this leads to constipation ● Bone health ○ Adequate levels are needed ■ Protein ■ Vitamin D, calcium ● C: for women > 50 take 1200 mg ● C: for men > 50 take 1000 mg ● C: for men and women > 70 = 1200 mg ● VD: > 50 DRI is 800 mg ● VD: > 70 DRI is 1000 mg ○ Decreases falls and maintains strength ■ Phosphorous, magnesium ○ May consider low than DRI ■ Sodium ● Increases calcium excretion so we want to decrease this ■ Vitamin A ● Clearance not as fast as it used to be  ● Cognition ○ Vitamin B12 ○ Vitamin B6 ○ Folic acid ○ Omega 3 FA ● Immunity ○ ○ ○ ○ Zinc Vitamin C Protein Vitamin D  6.Summarize risk factors, signs and symptoms and treatment of osteoarthritis ● Risk factors ○ Advancing age ○ Obesity ○ Female ○ Injuries ○ Overuse ○ Malformed bones or joints ○ Rheumatoid arthritis ○ Gout ● Signs and symptoms ○ Pain ○ Stiffness ○ Swelling ○ Numbness ○ Decreased mobility ○ Crepitus ● Treatment ○ Medications ○ Supplements ○ Diet ○ Exercise ○ Relaxation ○ Surgery ○ Maintain healthy weight + ■ Inflammatory compounds ■ Antioxidants (E,C) ■ phytochemicals  7. Outline the social and economic impact of aging and available assistance. ● Income ○ 3.5 million in poverty ■ 9% of population ● Dependent living ○ Assisted living ○ Nursing home ● Depression ○ Retirement ○ Loss of friends ○ Isolation  ● Nutrition assistance ○ Older Americans act of 1965 ■ Nutrition services to low income ■ Congregate meals ■ Home delivered meals ○ SNAP ○ Nutrition screening initiative ■ Led by american doctors to provide nutrition screening Chapter 19: Osteoporosis You should be able to: 1.Define: osteoclast, osteoblast, sarcopenia ● Osteoclast ○ Dissolve bone through enzymes ● Osteoblast ○ Lay protein/minerals (matrix) ● Sarcopenia ○  2.Discuss bone remodeling including in your discussion the RANK/RANKL/OPG Pathway ● Bone remodeling ○ Osteoclasts dissolve bone through enzymes ○ Osteoblasts lay protein/minerals (matrix) ○ New bone (osteoid) ■ Mostly collagen ■ Hardens over 3 years ○ 8% being remodeled any one time ■ 5 years trabecular bone (shorter time) ■ 13 years cortical bone (longer)  ● RANK/RANKL/OPG pathway → involved with bone moedling ○ Signaling regulates osteoclast formation, activation and survival in bone modeling and bone remodeling ○ Bone resorption ■ Performed by active osteoclasts ● Regulated by RANKL in normal processes ○ RANKL: controls osteoclast differentiation proliferation and survival ● Bind to RANK to upregulate osteoclast activity ○ Bone formation ■ Performed by inhibiting osteoclasts and stimulating osteoblasts ● OPG is a decoy receptor (or natural inhibitor) for RANK ○ Suppresses osteoclast activity  3.Distinguish between modifiable and nonmodifiable risk factors for osteoporosis ● Non Modifiable risks ○ Older age ○ Female ○ Early menopause ■ Loss of estrogen ○ Race ■ White women 2x more likely than black women ○ Genetics ○ Family history  ● Modifiable risks ○ Nutritional status ■ Body weight ■ Physical activity ● Low activity = less remodeling occuring ● Leads to loss of bone and muscle tissue ■ Nutrient intake ● Calcium, vitamin D, boron ○ Smoking ■ Tobacco reduces calcium absorption ○ High caffeine intake ■ Can impact bone density ○ Alcohol abuse ■ Vitamin D metabolism ○ Some medications ■ Thyroid, steroids 4. Identify the tool used to determine bone density and interpret results from the tool. ● Bone densitometry DXA Spine and hip BMD Low level radiation Compares to peak bone mass Measured at T-score and compare it to a women age 30 ■ Standard deviation above and below the bone mass for sex/age/race ○ Osteoporosis scoring ■ 0–>-1 : normal ■ -1–> -2.5 : osteopenia ■ -2.5–> : osteoporosis  5. Describe the optimal lifestyle for bone health. ● Weight bearing exercise: so important ● Diet ○ Minerals : Ca, Mg, Zn, K ■ Ca2: 12oo mg after 50 ○ Protein: 1 g/kg ■ Less fractures ○ Vitamins : C, D, K ■ VD: muscle strength, less falls ■ VK: synthesis of bone matrix + VC ○ Alkaline diet: don’t require neutralization form minerals ■ High in fruits and vegetables don’t need to be broken down in acids ○ Soy? ● Sun exposure  6. Compare medications to decrease fracture risk. ● Bisphosphonates : inhibit bone resorption (still filled by osteoblasts) ○ Fosamax, boniva, actonel, reclast ■ Inhibit pyrophosphate synthase ● Enzyme necessary for formation of osteoclast cytoskeleton ■ Do no inhibit osteoblasts ● Initially increase in BMD, while osteoblasts refill ■ After taken for several months- 1 year ● Resoprtion and formation low ■ Side effects ● GI upset, esophageal inflammation, atypical fractures ● Denosumab : inhibit bone ○ Prolia ○ ○ ○ ○ ○ ■ Inhibits bone resorption via monoclonal antibody to RANK-ligand ● RANKL made by osteoblasts to make osteoclasts ■ Mimics OPG ● Overall decrease in osteoclasts ■ Side effects ● Hypocalcemia, cellulitis, eczema ● Hormonal ○ Estradiol ■ Estrogen hormone therapy ● Decrease bone resorption ○ Decrease RANKL production ○ Increase OPG ■ Decrease osteoclasts ■ Side effects ● Breast cancer, heart disease  ○ Selective estrogen receptor modulators (SERM) ■ Raloxifene (evista) ● Acts as estrogen in some tissues (bone) ○ Not in others (breast and uterus) ● No risk of breast cancer ● Slightly less effective then bisphosphonates ■ Side effects ● Hot flashes, leg cramps, deep vein, thrombosis  ○ Calcitonin ■ Hormone made by thyroid gland ● Decrease osteoclast activity ○ Binds osteoclasts (NOT associated with RANK-L) ● Can increase BMD by 5% when taken with Ca2+ ● Comes in a nasal spray ■ Side effects ● Nasal irritation ● back/joint pain ● Congestion ● Bloody urine    ○ Parathyroid hormone (forteo) ■ Teriparatide ● Regulator of blood calcium ● In synthetic form, intermittent exposure ○ Increase osteoblast activity ● Once daily injections = new bone formation ● Use less than 2 years ■ Side effects ● Nausea ● Leg cramps ● Dizziness ● Risk of osteosarcoma .  