Nutrition Across the Lifespan Quiz
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AdultNutrition.pptxAdult Nutrition
Class Objectives
By the end of this class, the student will be able to:
Understand physiologic changes of adulthood
Recognize how to assess body weight, macronutrient and energy needs in adulthood
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Definition of Adulthood in the Life Cycle
Early adulthood—ages 20-39 yrs
Midlife—ages 40 to 64 yrs
“Sandwich” generation – the 50’s
Later adulthood—age 65+
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Physiological Changes of Adulthood
Growing stops by the 20’s
Bone density continues until 30
Muscular strength peaks around 25 to 30 years of age
Decline in size and mass of muscle and increase in body fat
Dexterity and flexibility decline
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Physiological Changes of Adulthood
Hormonal and Climacteric Changes
Women
Decline of estrogen menopause
Increase in abdominal fat
Increase in risk of cardiovascular disease & accelerated loss of bone mass
Men
Gradual decline in testosterone level & muscle mass
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Physiological Changes of Adulthood
Body Composition Changes in Adults
Bone loss begins around age 40
Positive energy balance resulting in increase in weight and adiposity; decrease in muscle mass
Fat redistribution- gains in the central & intra-abdominal space, decrease in subcutaneous fat
Associated with increased risk of chronic disease
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Body Fat
| Location | Men | Women |
| Essential Fat | 2.1 | 4.9 |
| Storage Fat | 8.2 | 10.4 |
| Intermuscular | 3.3 | 3.5 |
| Intramuscular | 0.8 | 0.6 |
| Thoracic & abdominal | 1.0 | 1.2 |
| Subcutaneous | 3.1 | 5.1 |
| Total Fat | ~10.5 | ~15.3 |
| Body Weight | 70.0 | 56.8 |
| % Fat | 14.7 | 26.9 |
Gibson, 2004
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BMI - Adults 18 and <65 years
| Classification | BMI | Risk of Developing Health Problems |
| Underweight | 18.5 | Increased |
| Normal Weight | 18.5-24.9 | Least |
| Overweight | 25.0-29.9 | Increased |
| Obese Class I | 30.0-34.9 | High |
| Obese Class II | 35.0-39.9 | Very High |
| Obese Class III | 40.0 | Extremely High |
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BMI - Adults
| BMI | Protein Energy Malnutrition |
| >18.5 | Absent |
| 17.0-18.4 | Mild |
| 16.0-16.9 | Moderate |
| <16.0 | Severe |
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BMI - Adults > 65 years
| BMI | Interpretation |
| < 24 | May be associated with health problems in some elderly |
| 24.0 – 29.0 | Healthy weight |
| > 29.0 | May be associated with health problems in some elderly |
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Health Risk by Waist Circumference Adults 18
| WC Cut-Off Points | Health Risk (relative to WC below cut-off point) |
| Men 102 cm (USA 40”) | Increased risk of developing health problems: diabetes, coronary heart disease, hypertension |
| Women 88 cm (USA 35”) |
For BMIs in the 18.5 - 34.9 range, use WC as an additional indicator of health risk
For BMIs 35, WC measurement does not provide additional information regarding level of risk
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Ideal Body Weight (IBW)
Hamwi Method
Men = 106 lbs for 5 ft + 6 lbs per inch over 5 ft
Women = 100 lbs for 5 ft + 5 lbs per inch over 5 ft
BMI Method (adults only)
Healthy range 18.5-24.9 kg/m2
Based on current height estimate ideal weight using BMI
Example. Tony is 170 cm tall, what his IBW ?
Lower end of range weight=(1.7)2x18.5 =53.5 kg (upper end =72 kg)
Ideal weight range using BMI 53.5 to 72 kg (63 kg is the mid-range) or just use mid-point BMI =(1.7)2x 21.7=63 kg
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% IBW
% IBW: (Current Weight / Ideal Weight) x 100
>200 Morbid Obesity
130 - 199 Obese
110 - 129 Overweight
80 - 90 Mild Malnutrition
70 - 79 Moderate Malnutrition
< 69 Severe Malnutrition
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Case Example I: Laura
54 yo female, 168 cm, usual weight 120 kg prior to gastric bypass surgery, current weight 80 kg
Assess body weight as:
% IBW
BMI risk category
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Case Example I: Laura
54 yo female, 168 cm (66 inches or 5’6’’), usual weight 120 kg (264 lbs) prior to gastric bypass surgery, current weight 80 kg (176 lbs)
Assess body weight as:
% IBW
BMI risk category
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Adjusted Body Weight
Overweight >125% IBW
Adjusted weight = ((Current weight – IBW) x 0.4) + IBW (use kg)
Actual weight used for new equations that already account for body weight
Mifflin St. Jeor equation does not require adjustment for body weight
Body Weight Planner (NIH, NIDDK)
A web-based simulation for setting goals for weight loss & maintenance
www.niddk.nih.gov/health-information/health-topics/weight-control/body-weight-planner/Pages/bwp.aspx
Estimating Energy Needs in Adults
Estimating Energy Needs Based on BMR+TEF+Activity
Basil Metabolic Rate (BMR)
Daily BMR expenditure- 60 to 75% for involuntary processes
Thermic Effect of Food (TEF)
TEF (metabolism of food) ~10%
Activity thermogenesis
Activity- most variable component is which accounts for 20-40% of total energy needs
Based on Doubly Labeled Water or Indirect Calorimetry
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Estimating Energy Needs in Adults
Mifflin-St. Jeor Energy Estimation Formula
Validated and more accurate than old Harris-Benedict equation
Mifflin-St. Jeor Formula
Males: REE = (10 x wt) + (6.25 x ht) – (5 x age) + 5
Females: REE = (10 x wt) + (6.25 x ht) – (5 x age) – 161
W= weight in kg
H = height in cm
A = age in years
REE x Activity Factor x Stress Factor = kcal/d
NOTE: only difference is last part of equation.
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Activity Factors
Critical phase, mechanical ventilation 1.06 - 1.18
Sleeping 1.2
Ambulatory or Sitting 1.3
Light activity 1.5
Moderate activity men 1.8, women 1.7
Intense activity men 2.1, women 1.8
Very intense activity men 2.3, women 2.0
Stress Factors
Malnutrition 0.85-1.00
Elective surgery – no complications 1.05-1.15
Elective surgery – complications 1.25-1.40
Solid tumor 1.10-1.25
Sepsis 1.20-1.40
Pancreatitis (acute) 1.10-1.20
IBD – active without infection 1.05-1.10
Severe head trauma – with sedation 1.15
Severe head trauma – without sedation 1.30
Severe head trauma – coma & barbiturates<0.9
Polytrauma 1.25-1.40
Estimating Energy Needs in Adults
“Ballpark” caloric levels
Simple calculation
Weight maintenance =
15 calories per pound
Weight loss =
13 calories per pound
Weight gain =
17 calories per pound
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Energy Adjustments for Weight Change
1 lb of body fat = 3500 calories
To lose 1 lb a week, an adult would need to create a negative balance of 500 calories per day
A combination of decrease intake and increased use (i.e. exercise) is one approach to use
A positive balance of just 100 extra calories per day will result in a gain of 10 lbs in a year
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Nutrient Recommendations
Acceptable Macronutrient Distribution Ranges (AMDRs)
Fat 20-35% of calories
Carbohydrate 45-65% of calories
Protein 10-35% of calories
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Dietary Recommendations
IOM Dietary Reference Intake
Dietary Guidelines for Americans and MyPlate
Dietary guidance systems
Voluntary health organizations make additional science-based recommendations
American Cancer Society
Nutrition and Physical Activity Guidelines
American Heart Association
Diet and Lifestyle Recommendations
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Fluid Needs
Dehydration vs. over hydration
Can be estimated based on different methods
Energy
1 ml per kcal
Age
16-30 y, active: 40 ml / kg BW
20-55 y: 35 ml / kg BW
55-75 y: 30 ml / kg BW
>75 y: 25 ml / kg BW
Weight
100 ml per kg for first 10 kg
50 ml per kg for next 10 kg
20 ml per kg for each kg above 20 kg
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Case Study II: Kristen
Kristen is 25 years old, 5’8’’ and 135 lbs
24-hour recall:
2090 kcal, 350 g carbohydrates (41 g fiber), 98 g Protein, 33 g Fat (7 g saturated, 1 g trans, 99 mg cholesterol)
What is Kristen’s BMI? What is her IBW?
How many calories does Kristen needs to maintain her weight?
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