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Credit: RAMON ANDRADE 3DCIENCIA/SCIENCEPHOTO LIBRARY
FOODAverage volumeof soft drinkconsumed perperson per yrFast foodburger fatcontent istwice thelevel1970PORTIONSIZEStandardpacket ofchipsINACTIVITY in number of cars drivento work each day inAustralian capital cities70%(>1.4 millioncars)
# WHO 2000, AIHW (2004)*Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data)6Classification # BMI (kg/m2) IBW % * Risk of ChronicDiseaseUnderweight <18.5 >10% below* Low (but otherrisks)Normal range 18.5-24.9 desirable AverageOverweight >25pre-obese 25.0-29.9 (10-19% above*) Increasedobese class I 30.0-34.9 (>20% above*) Moderateobese class II 35.0-39.9 Severeobese class III >40 Very severe
BMI classification in kg/m27Asian Pacific Is.<18.5 <19.9 Underweight18.5-23.9 20.0 - 26.9 Normal weight24.0-26.0 27.0-32.9 Overweight27.0-39.0 33.0-39.9 Obesity
BMI measures don’taccurately representhealthy weights ofpeople who: are athletes with ↑muscle mass have ↓ muscle mass have dense, large bones are dehydrated or over-hydrated
1. Waist circumference (AIHW,2005) > 18 y >94 cm (M) >80 cm (F) –abdominal overweight >102 cm (M) >88 cm (F) –abdominal obesity2. Waist: hip ratio visceral fat around organs vs.subcutaneous fat on hips optimalWHR is < 1 (M) or <0.8 (F)
energy intake > energy expenditure Not a lot extra required to allow slow weightgain over the years↑ food intake = ↑ wt gained+420 kJ/day = +4.5kgs/yr
↑ Portion sizes The food industry includingadvertising Eating out ↑Variety/flavours of food ↑ Availability/affordability of energydense foods Higher socio-economic status The “killer combination of salt, fat &sugar” Less restrictive clothing? High fructose corn syrup – rarelyused in Aust(David Kessler,The End of Overeating; Bray & Champagne, 2005,Beyond energy balance)
↑ Car ownership Sedentary Leisure activities Technological innovations →↓manual jobs ↑Affordability of washing machinesetc Education Shopping changes Houses/shopping/work placeswarmer Fear for children’s safety
>>3 X ↑ Risk 2 -3 X ↑ Risk Up to 2 X ↑ RiskType II DiabetesGall-bladderdiseaseDyslipidemiaInsulin resistanceBreathlessnessSleep apnoeaCardiovasculardiseasesHypertensionOsteoarthritis (inknees)CancerImpaired fertilityLower back painRisk of anaesthesiacomplicationsFoetal defectsassociated withmaternal obesity13
1Kg = 32.3 MJ so to lose 1Kg/ wk you need to burn off 32.3 MJ/ wkActivity Av E expenditure(MJ/hr)sitting easy 0.4fidgeting up to: 0.5walking 1.0dancing 1.2cycling 1.7swimming 2.4skiing cross country (max) 4.214
Goal: to lose 0.5 - 1 Kg /wkSo (in theory): To lose 1Kg = 32.3 MJ, you need to energy intake by 4.6MJ/d:e.g.Consume 4.0 - 5.0 MJ/d (women) (from 8-9MJ)Consume 6 - 8 MJ/d (men) (from 10- 12 MJ) Improve weight maintenance with physical activity &behaviour modification15
1. An absolute reduction from baseline of2000kJ/d2. A relative reduction from baseline eg 25%3. An intake below that required for weightmaintenance (4,500-5,000 kJ/d forwomen, 5,500-6000 kJ/d for men)4. Qualitative modifications e.g. swapenergy dense for less energy dense foodsor remove reduce portion sizes16
Genes Hormones Hunger PsychologicalFactors Social Factors Disease MedicationsWhy is something so simple sohard?
Weight Loss InterventionsDiet &NutritionActivityBehavioural/CognitiveTherapyPharmacotherapy Surgery
Increase in the absolute & relative number of olderpeople in both developed and developing countries 2000: 580 million > 60 y 2020: 1000 million > 60 yIn Australia Proportion of the Population 65+Y 1861: 1% 1900: 4% 1970: 8% 2001: 13% 2052: 25%
Chronological age: years since birth Biological age: decline in function that occursin every human with time Compression of morbidity Evidence of improvements in biologicalage → not only genes but also lifestylecan influence ageing
NO Age 65 y life expectancy 15 & 19 y in M & F Evidence interventions have worthwhileadvantages in elderly age groups E.g. increased activity, smoking cessation,reduced saturated fat intake, reduced sodium,weight reductionMann JM,Truswell ST, eds. Essentials of human nutrition. NewYork, OxfordUniversity Press, 1998:499–511.
Oral Health Xerostomia Dental problems Gastrointestinal motor function & muscle tone digestive capacity Diverticula Metabolic Glucose tolerance Basal metabolic rate Cardiovascular heart muscle, vessel elasticity LDL cholesterol to 60 y (M) 70 y (F)
A condition or syndrome that results from amulti-system reduction in reserve capacity tothe extent that a number of physiologicalsystems are close to, or past, the threshold ofsymptomatic clinical failure Increased risk of disability and death fromminor external stresses 6 to 25% of 65 year olds and 25 to 40% of 80Y +5/15/2013 27
Poor appetite Fatigue Physically inactivity Slow and unsteady gait with ↑risk of falling Increased risk of impaired cognition Sarcopenia Osteopenia Fracture Depression Reduced lifespan5/15/2013 28
Dietary patterns generally similar to orhealthier than those of younger counterparts Intakes of cereals, fruit, vegetables & milkbelow recommended Need for more recent research See tables 27.2 and 27.3 ofWahlqvist edition 3for details5/15/2013 29
Diminished ability to defend againstdehydration with age Reduced thirst sensation Lower % body water Impaired renal function Impact of conditions Urinary problems5/15/2013 30
Sense of smell Taste buds Alterations in brain control of appetite Alterations in signals from stomach gastric emptying rate
Cognitive impairment Depression Bereavement Alcoholism Cholesterol phobia Choking phobia/Food phobias Sociopathy (loss of locus of control) Food faddism
Low SES groups Older men alone Social isolation,lonely Poor nutritionalknowledge Institutionalized Limited food storage Shopping difficulties Inadequate cookingskillshttp://www.guardian.co.uk/society/2009/jul/01/public-services-reforms
Older adults acceptable range: 23-28 kg/m2Grade 1 malnutrition or PED: 17–18.5 kg/m2Grade 2 malnutrition or PED: 16–17 kg/m2Grade 3 malnutrition or PED: <16 kg/m2
in lean mass & abdominal fat Caused by illness &/or inadequate food intake More common amongst institutionalized Underweight increases risk of Hip fractureReduced mobilityIncreased Mortality Even those with apparently adequate fat andmuscle are at increased risk if recent, rapidweight loss
A systematic skeletal disease characterized by lowbone mass & micro-architectural deterioration ofbone tissue with a consequent increase in bonefragility & susceptibility to fracture (ConsensusDevelopment Conference, 1993)
Essential to achieve peak bone mass Attenuates loss of BMD with ageAge RDI (mg/d)Males19-70 y> 70 y y10001300Females19-50 y51 + y10001300
Vitamin D Regulator of calcium balance Essential for normal mineralization of bone Not widespread in food-chain 80-90% of requirements from sunlight People with limited sun exposure most at risk
BMI/Body weight Positive association between BMI/body weight &BMD of spine & femur Could be due to▪ bone mass/muscle strength▪ nutrient intake▪ Forces on bone▪ OestroneCredit: ZEPHYR/SCIENCE PHOTOLIBRARY
PhysicalActivity BMD ↑ to adapt to mechanicalstress BMD Decreases when stress isremovedCredit: DAMIENLOVEGROVE/SCIENCE PHOTO LIBRARY
In older adults, weight-bearing& resistance exercise ↑ LBM &bone density Prevention & treatment ofobesity, CHD, type II diabetes,osteoporosis Prevention & reversal ofsarcopenia Increased appetite & energyexpenditure Mental & emotional benefits Functional status &independence Check with GP firstCredit: MAUROFERMARIELLO/SCIENCE PHOTOLIBRARY
Emphasize healthy traditional vegetable- andlegume-based dishes Limit traditional dishes/foods heavilypreserved/pickled in salt & encourage use of herbsand spices Introduce healthy traditional foods or dishes fromother cuisines
Select nutrient dense foods such as fish, lean meat,liver, eggs, soy products, & low fat dairy, yeast-based products (e.g. spreads), fruit & veg, herbs &spices, whole-grain cereals, nuts & seeds Consume fats from whole foods. Where refined fatsare necessary for cooking, selects from liquid oils,including those high in -3 & -6 fats
Enjoy food & eating in thecompany of others. Avoid theregulatory use of celebratoryfoods. Encourage the food industry &fast-food chains to produceready-made meals low inanimal fats Eat several (5-6) small non-fatty meals Avoid dehydration byregularly consuming fluids andfoods with a high watercontentCredit: MARTIN RIEDL/SCIENCE PHOTO LIBRARY
Transfer as much aspossible of one’s foodculture, health knowledge& related skills to one’schildren, grand-children &the wider community Be physically active on aregular basis & includeexercises that strengthenmuscles & improvebalancehttp://www.thegoodfoodbully.com/2010/09/its-my-grandmas-recipe.html
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