Nutrition SG - Physical Exam

22 BMI underweight Physical Exam 1. 2. 3. Obtain height and weight at each visit to calculate BMI a. BMI < 22 ⇒ Underweight b. Best BMI for older adults is 25 c. Obtaining a correct BMI may be difficult due to alterations in height (kyphosis, etc..) Signs and Symptoms to look for a. Muscle wasting (sunken temples) b. Ill-fitting dentures c. Mouth sores/abscesses Very important to examine patients with cognitive impairment a. May not be able to verbalize constipation, urinary retention, abd discomfort Signs and Symptoms to look for: Key Micronutrient Requirements ⇒ Older adults require higher levels of certain vitamins and minerals. Nutrient RDA Importance ● ● ● Vitamin D 600 IU (51–70 years) 800 IU (71+ years) ● ● Males 51–70: 1,000 mg Calcium ● ● Males age 71+: 1,200 mg/day Females 51+: 1,200 mg ● ● Vitamin B12 2.4 µg/day 51 yrs+ ● ● Prevents osteoporosis Reduces fall risk In North America, it is estimated that 50% of the population is deficient in Vitamin D Vitamin D should be routinely assessed + supplements prescribed if needed Supplementation improves muscle strength, walking distance, functional ability Maintains bone density Prevents fractures, osteoporosis LARGE disparity between need and consumption A B12 supplementation should be considered in this patient population Levels should be monitored regularly Low stomach acid secretion, secondary to atrophic gastritis, may seriously impair the absorption of Vitamin B12 in those over age 50 ● ● Folate 400 µg/day 51 yrs+ ● ● ● ● Iron 8 mg/day 51+ Inadequate folate statu ⇒ hyperhomocysteinemia⇒ increase the risk of CAD Folate supplementation likely not needed Stroke risk dec. after folic acid fortification ○ Excessive consumption of fortified foods can mask a B12 deficiency Prevents anemia Supports oxygen transport When inadequate, appropriate supplementation should be prescribed ○ Want to encourage a stool softener as constipation is a common side effect Hydration and Fluid Needs ● Older adults are at higher risk of dehydration due to: ○ Reduced thirst response ○ Impaired kidney function ○ Fear of incontinence ○ Cognitive decline (forgetting to drink) (increased risk of dehydration and UTIs) ● Hydration Guidelines ○ Encourage 6-8 glasses of water/day. ○ Monitor fluid intake in kidney or heart disease patients. ○ Avoid sugary drinks for diabetics. Health Literacy in Older Adults ● ● Many struggle to understand health information, affecting: ○ Medication use ○ Food choices ○ Label reading ○ Cognitive decline and past education levels influence literacy. ○ Nutrition education programs can improve dietary habits. Education does NOT guarantee the ability to read Nutrition in Infants, Children & Adolescents Introduction to Pediatric Nutrition ● ● Nutrition during infancy, childhood, and adolescence significantly impacts both short- and long-term physical and cognitive health. Overweight and obese children increases the risk of chronic diseases such as: ○ Type 2 diabetes (DM2) ○ Hypertension (HTN) ○ Cardiovascular disease (CVD) Age Classifications Stage Age Range Birth 12month Infancy Birth–12 months Toddlerhood 1–3 years Preschool 3–5 years 3 Syrs Middle Childhood 5–10 years 5 10yrs Pre-Adolescence Adolescence Girls: 9–11 years Boys: 10–12 years Girls: 11–21 years Boys: 12–21 years 1 3 yrs 95112 Pre Adolescence Adolescence lbs Stage** Toddlers (1–3 years) Preschoolers (3–5 years) School-age children (5–10 years) Average Growth per Year Iiiiii t.ae in +6 lbs www.tsiiiiiii +4.8 inches +4.4 lbs +2.75 inches sarge +7 lbs iiiii.li 2.5 inches ⇒ Adolescent Growth: ● ● Males: Increase in muscle mass. Females: Increase in fat mass for reproductive development. ⇒ BMI Growth Charts FATMASS BM - BMI is more predictive of body fat** BMI-for-age is used after age 2+ Goal: Strive for BMI-for-age is to be within normal range, NOT a specific value Interpretation: if a male child is at the 90th% for weight-for-age, then that child weighs more than 90% of the males of his same age ● ● ● ● Appropriate growth: 10th–90th percentile* Underweight: Below 5th percentile* Overweight Overweight: 85th–95th percentile* Percentile Obese: Above 95th percentile* ○ Need very close eval if readings are consistently greater than 90th or less than 10 % 1eetieleation.si Eritntie 8595ᵗʰPercentile 95ᵗʰ eval if 90 consistently afiii.ieitowtn Obese Key Micronutrient Needs: Nutrient Vitamin D Iron RDA 400 IU/day (infants)* Importance the 600 IU/day (children 1–12)* is ● Bone development, prevents rickets 49stt.fr 14-18 yr old boys: 11 mg/day* esticEmensturat ● 14-18 yr old girls: 15 mg/day* Prevents anemia, essential for brain development 15mg day Calcium 1,000–1,300 mg/day ● Supports bone growth Fiber No specific RDA ● Prevents constipation, supports gut health I ○ Prevention Strategies: ■ Behavioral therapy ■ Reduce sedentary behavior ■ Nutritional education ■ Physical activity promotion ■ Notice growth chart trends early ■ Consistent environment Promoting a Healthy Lifestyle in Children ● Family-Based Recommendations ○ Encourage vegetables, fruits, and whole grains. ○ Include lean protein sources and dairy. ○ Promote physical activity. ○ Limit screen time. ○ Avoid forcing children to “clean their plates”. ○ Involve children in meal prep and grocery shopping. ○ Plan nutritious snacks. ○ Encourage mindful eating—eat slowly and stop when full. ● ● Clinical Challenges: ○ Cardiac cachexia (muscle wasting + undernutrition) ■ Protein/Fat Malabsorption ■ Decreased nutrient intake ○ Reduced energy intake due to fatigue, nausea ○ Hypermetabolic state requiring increased nutrition Nutritional Goals: 1. Sodium restriction: 2-3 g/day 2. Fluid restriction: ~2 quarts/64 ounce/8 cups per day 3. Adequate caloric intake: 1.5 x BMR 4. Protein intake: 1.1–1.4 g/kg/day 5. Small, frequent meals to prevent fatigue 6. High-calorie, high-protein supplements if needed Nutritional Needs for Lactating Women: ⇒ Approx 85 kcal are required to produce 100 mL of breast milk ⇒ Prenatal vitamins are often recommended for lactating women to ensure adequate intake Nutrient Recommendation Calories +400–500 kcal/day Protein 71 g/day Calcium No extra intake needed Iron During lactation: 9 mg/day When menstruation resumes: 18 mg/day Fluids 128 oz/day (16 cups) Postpartum Preeclampsia ● ● ● ● High blood pressure and excess protein in your urine soon after childbirth Can occur up to six weeks post-delivery. Most cases of postpartum preeclampsia develop within 48 hours of childbirth. Untreated cases may lead to seizures and maternal mortality.