1. Toddler to Teens- Older Adult

2. Objectives- Toddlers to Teens State 3 nutrition related principles for feeding 1-5 year olds Identify fluid needs for hydration during illness State 3 nutrition related principles for 5-10 year olds Identify 4 components to a weight management program for kids Identify calories and nutrients needed by teens Identify 4 nutrition related issues for teens. State reasons to increase meals for kids

3. Objectives- Older Adults Identify 7 most significant nutrition concerns with aging Identify strategies to prevent weight loss Define sarcopenia Identify strategies to increase protein List vitamin D needs Identify 4 side effects of dehydration State 2 most significant “red flags” for malnutrition

4. Objectives- Older Adult Identify side effects of malnutrition State the importance of “liberalizing” the diet for older adults Describe ways to improve dietary intake and eating environment for older adults List 6 lifestyle factors related to longevity

5. 1-5 years Rate of growth slows Add 200 calories per year 2 yo ~1000 calories, 3 yo ~ 1200 calories Appetite dependent of activity level and growth spurts “picky eating”, “food jags”

6. 1-5 years Food Provides Nutrients Decision making, motor skill development My Plate Balance Model good eating patterns Provide healthy choices Smaller portions 1 Tblsp. year portions Establishment of eating behaviors, food preferences Dental Caries No bottles in bed

7. Stool Concerns Stooling Stool consistency and frequency varies DISCOMFORT Diarrhea-Dehydration Viral infection, formula contamination, antibiotics Replace fluids Oral hydration formulas 2 oz of fluid per pound of body weight

8. Best Time to Teach Nutrition Pre-school and grade school years Love to cook, help with food 3 yo- wrap, pour, mix, shake, spread 4 yo- roll, juice, mash, peel 5 yo- measure, grind, grate, cut Less peer influence

9. 5-10 Years Continued slow growth 10 y.o.- 1800 calories/day Regular meals and snacks 5-7 eating times/day Breakfast, snacks, < sweetened beverages Concerns Dental caries, iron deficiency anemia Obesity High blood cholesterol (>170 mg/dl), hypertension, high blood sugars

10. Obesity BMI 85 th -95 th percentile- at risk > 95 th percentile- obese Healthy Diet Portion control Balance Physical Activity Self-Esteem Family involvement

11. Adolescents Rapid growth triggered by hormones Girls 10-11 y.o., fat increases, 35 pounds, 6” Boys 12-14 y.o., muscle increases, 45 pounds, 8” Calories up to 4000-5000/day during growth spurts Iron, calcium, vitamin D, protein

12. Nutrition Issues Peer influenced eating Eating disorders Obesity Iron deficiency anemia Low calcium intake- girls Vegetarianism Sports nutrition Adequate calories to support growth and activity +500-1500 calories/day

13. Importance of Mealtime Better….. School performance, health, family relationships Nutrition Intake Adequate vegetables, fruit, low-fat dairy, grains, fewer soft drinks/empty calories Social skills Family time Distraction-free Enjoyable Try to increase!

14. Older Adults General decrease in all physiological functions Wide variation physical and cognitive abilities Great variations in nutritional needs, social, economic, lifestyle Various levels of nutrition Health improvement Treatment Support life

15. Sensory Losses Taste Smell Vision Thirst

16. Most Significant Nutrient Concerns with Aging… Unintentional Weight Loss Loss of Lean Body Mass Low vitamin D Dehydration Malnutrition Depression Food Insecurity

17. Weight Loss middle age- weight gain; peak weight- 75 yo, weight loss- after 75 Difficulty regaining weight Loss of functional ability 25-30 calories/kg body weight

18. Strategies: Calories Avoid unnecessary dietary restrictions Encourage use of nutrient dense foods Use more frequent meals plus supplements or snacks

19. Strategies: Calories Use foods that are well liked frequently Provide double portions of favorite foods Add calories by using sauces, gravies, toppings, and fats Emphasize calorie containing liquids to meet fluid needs

20. Sarcopenia Loss of lean body mass Affects physical function, strength, overall health, quality of life, activities of daily living Adequate Calories Adequate Protein 1.2 grams/kg Animal sources, supplements 25 grams at a time (snacks and meals) 3-5 times a day Resistance Exercise

22. Food Protein Sources (grams) 3 oz meat = 21 1 oz meat = 7 1 cup milk = 8 1 cup yogurt = 8 2 T. peanut butter = 7 1 egg white = 7 ½ oz. nuts/seeds = 7 ½ c. legumes/soy = 7 ½ cup grain = 3 1 slice bread = 3 ½ cup vegetables = 2 1 cup soy milk = 8 ¼-½ cup meat substitute = 7- 14 Veggie Burger = 14 ½ oz. tofu = 18 Scoop of protein powder = 24 Protein Bars- 7-14 MyPlate- 76 grams

23. Dietary Protein/Calorie Supplements Liquid supplements Liquid supplements 13+ grams 13+ grams Protein powders Protein powders 25 grams a scoop 25 grams a scoop Smoothies Smoothies Food intake is often ↓ by use of these supplements, but overall nutritional intake is improved Food intake is often ↓ by use of these supplements, but overall nutritional intake is improved Considered a “supplement” not meal replacement Considered a “supplement” not meal replacement

24. Oral Supplements 100 kcal/1 oz 10 gm protein 330 kcal/1.5 oz 7 gm protein 6 gm/pkt 23 kcal/Tbl

25. Vitamin D 2010 Dietary Guidelines 600 IU up to 70, 800 IU after 70 Common Supplementation- 1000 IU Repletion Guidelines (based on lab tests) 50,000 IU for 6 weeks 1000 IU a day

26. Dehydration Affects constipation, blood pressure, dementia (confusion), muscle function 8-11 cups of fluids a day Ideas to increase intake: Availability, pitchers, variety of fluids, flavors

27. Malnutrition Risk DETERMINE Disease Eating Poorly Tooth loss or mouth pain Economic hardship Reduce social contact Multiple medications Involuntary weight loss or gain Need for assistance with self care Elder at an advanced age

28. Malnutrition Easier to prevent than to cure… Side Effects Poor immune system Frequent illness Increased risk for infection Poor wound healing Poor drug tolerance Skin conditions Depression, apathy Weakness Dehydration Unnecessary or long hospital stays

29. Long-Term Care Liberalize the diet Quality of life issue All issues covered…+ pressure ulcers

30. Pressure Ulcers, Decubitus Ulcers, Bed Sores Pressure, poor nutrition High calories and protein Vitamin C 500 mg a day Zinc Sulfate 220 mg for 14 days Multivitamin-mineral Hydration

31. Encourage Healthy, Regular Eating Eat regular/routine, small, frequent meals Easy-to-prepare foods Flavorful, familiar foods Treats Good lighting cooking and eating areas Limit alone eating in isolation Physical activity Community Resources if food insecure

32. Live to Be 100 http://ngm.nationalgeographic.com/ngm/0511/sights_ n_sounds/index.html Mediterranean Type Diet Home-grown foods, fruits, vegetables, olive oil, fish, whole grains, drink tea-coffee-red wine, few processed or refined foods Maintain healthy weight Reduced calories and exercise Social Networks Family, friends, Spiritual life, “sabboth” Reason for living-purpose Rural living