Adulthood

Young Adults and Adults

Professor Robinson
Lifespan Nutrition
Johnson and Wales University

Adulthood
As a society, we can no longer afford to
make poor health choices such as being
physically inactive and eating an
unhealthy
diet..

US Surgeon General Richard Carmona

Adulthood Unit Objectives

1.

Identify specific nutrient needs of

adulthood

2.

List physiological reasons for

changes in energy needs

3.

Identify healthy lifestyle choices

Adulthood Unit Objectives

4. Describe Metabolic Syndrome

5. List risk factors for Metabolic Syndrome

6. Describe Transtheoretical Model for Change and

Motivational Interviewing

Emphasize

healthy
Young and Middle
Adulthood
food choices and benefits of PA
Ages ~20-64
To

reduce risk factors for

chronic disease

Early Adulthood-Final stages of growth

Bone Mass
2nd phase: Peak Bone Mass- between 20 and 30
3rd

phase: Bone loss between 30 & 40 when

bone loss begins to exceed new bone
formation.

Loss

not preventable but achieving maximum

mass in childhood can lessen the impact.

Bone mass is influenced by heredity, Ca++

and Vit D intake, physical demands on bone
(weight bearing)

Early Adulthood
~25-35 years of age
Often ignored in terms of health prevention
behaviors
Healthy

Eating
Active Living
Anticipatory

guidance????

BMI Classifications for Adults

18.5 Underweight

18.5-24.9

Normal

25.0-29.9

Overweight

30.0-34.9

Obesity I

35.0-39.9

Obesity lI

> 40

Extreme Obesity

Adulthood: Physiological Issues

Energy

Needs ~ 25 calories per kg.

Individual variability, esp. w/ activity

Energy

age

needs per kg. decline with

Changes in Body
Composition

1. 5 Vegetables: iceberg lettuce, potatoes: frozen,

fresh and potato chips and tomatoes = 52% of
our vegetable intake

What we eat:

USDA reports:

2.

High fat cheese > 40% of dairy choice. Intake

of milk declining with increase in soda

3.

Fruits 55% of all frt. Svgs. from orange and

apple juice, fresh apples, grapes and bananas

What we eat
Meat

(Protein) Group:

Most

from red meat, poulty, fish

and shellfish

Limited

intake of plant protein

sources: bean, lentils, tofu, eggs,
nuts

What we eat
Fats:

56%

from added fat rather than

the healthy fats found in some
plant foods

http://www.nejm.org/doi/full/10.1056/N
EJMoa1307352?query=TOC

Too Many Calories

1985-2000:

Increase

in caloric intake
by ~12% or 300 calories
per day with activity
decreasing or staying the
same

http://abcnews.go.com/GMA/video/america
ns-eat-570-calories-1977-obesity-snack13954992

What should we eat?

If it came from
a plant, eat it;
if it was made
in a plant, dont.

American Eating & Food

What

we eat

Weight Consequences

Do

Americans want to change?

Sudden

realization about ones health:

Examples:
Results of screening tests: Cholesterol, Blood
sugar, etc.
Self reflection when someone close becomes
ill

What Should We Eat?

- Total Diet Approach
Dietary
Guidelines 2010 (book only
- Reduce overweight/obesity
has 2005)

Plant

based diet with seafood and

low fat milk products
Fewer refined grains, less solid fat,
added sugars and sodium

Macronutrient Ranges same but more fiber

***Dietary Guidelines. Gov***

Emphasis on
1. Dietary

Variety

2. Eating

more of foods that are lacking

3. Eating

less of the unhealthy foods

4. Controlling

total calories

Major changes:2005 to 2010 Guidelines

Fish,

not meat

Lower

sodium

Risk Nutrients, p. 417, 419 and

420

Fiber: soluble: less absorption of

cholesterol from GI tract

Fiber:

insoluble helps prevent

constipation, GI cancers, diverticulosis

Any

fiber: promotes satiety

Risk Nutrients
Vitamin

A skin and mucosal membrane

integrity

Immunity

Vitamin D
Needed

for absorption of calcium in GI

tract to occur

Might

help with prevention in diverse

conditions such as cardiac disease,
some cancers, HTN, immunity, MS

Deficiency

is common

Choline
Might

help protect against fatty liver

Iron
o Needs decrease after menopause

Adult men often consume excess p.

420
Might contribute to CVD

Calcium

Along with magnesium and Vitamin D,

help with bone density and therefore
prevention of osteoporosis

Decreased
Decrease

risk of colon cancer

in HTN

Physical Activity Levels (PAL)

<

5,000 steps a day is sedentary

5,000

to 7,499- low active

7,500

to 9,999 - somewhat active

>10,000:

active

National Weight Control Registry

Successful weight maintainers:

> Fruits and Veggies [4-5 servings of each per day]

Breakfast eaters

No Meal Skipping

Calorie Controlled [1300-1700]

Exercise >One Hour 5X/ week

Weekly Weighing

Activity and Disease

Its

not just about obesity :

people

with low levels of physical

activity are more likely to have diabetes,
hypertension, heart disease, some types
of cancer and other chronic illnesses.

Sedentarism..

Common Chronic Diseases

Related to Lifestyle, p. 407, table 16.1
Cardiovascular
Type

Disease (CVD)

2 Diabetes

Cancers
Obesity
Osteoporosis

p. 407, sidebar on bottom right

genic = the beginnings of a process that
is expected to continue

Cardiovascular Disease (CVD)

Refers to conditions that involve:
narrowed or blocked blood
vessels
that can lead to a heart attack,
chest pain (angina) or stroke.

Blockage Progression
Atherosclerosis
Athero:

abnormal
fatty deposit
Sclerosis:

Hardening

Atherosclerosis

Hardening of the arteries. Pressure inside

arteries causes the muscles that line the walls of
the arteries to thicken.

Thickening causes the arteries to narrow.

Heart Attack: blood clot blocks blood flow to heart.

Stroke: blood clot blocks blood flow to brain

Risk Factors
A

risk factor is any behavior or condition that

increases a person's risk for a disease.

1. Modifiable Risk Factors: Lifestyle behaviors

Examples: smoking, diet, activity

2. Fixed Risk Factors:

Family history or genetics

Age
Gender

Nutrition and Disease

Prevention
Prevention

Ex. Cardiovascular Disease

PrimarySecondaryTertiary-

Risk

Factors

Non-Modifiable Risk Factors

Modifiable Risk Factors

CVD Risk is Same

2or more
Risk
Factors
Total Cholesterol

>180mg/dl

No Fixed
Risk
Factors
Total Cholesterol

>200mg/dl

HDL Cholesterol

<40mg/dl

>100mg/dl

LDL Cholesterol

>130mg/dl

Blood Pressure

120/80
mmHg

Blood Pressure

>130/85
mmHg

Weight

10% over
IBW

Obesity

20%>IBW

HDLCholesterol <40mg/dl
LDL Cholesterol

High Blood Pressure

The

heart pumps blood

through a arteries.

Flowing

blood pushes
against the arterial walls,
and this force is measured
as blood pressure.

What is High Blood Pressure?

Tightening

Arterioles

of small arteries called arterioles.

regulate blood flow through the body.

Arterioles and HTN

As

these arterioles tighten

(or constrict), the heart
works harder to pump
blood through the smaller
space, and the pressure
inside the vessels grows

High Blood Pressure

DASH diet- nih.nhlbi. Efficacy shown in NIH-funded

research

Rich in potassium, calcium, magnesium,

fiber, and protein. Low in sodium

DASH Diet- Dietary Approaches to

Ranked No. 1 out off 20 in best diets category: US
SNews
topping
Hypertension
and World Report.

http://www.npr.org/blogs/thesalt/2013/11/05/242994376/for-mind-bo
dy-study-finds-mediterranean-diet-boosts-both

DASH Diet Eating Plan

Emphasis on:
Fruits, vegetables(potassium, fiber)
Grains, especially whole grains

Low fat or nonfat milk/milk products (calcium)

Lean meats, fish and poultry; nuts and beans.
And, it contains all the healthy foods from the
Mediterranean diet.

Health Effects

lowers blood pressure

reduces cholesterol
improves insulin sensitivity.

Recommended by:
NIH, AHA, DGA
The DASH diet formed the basis for the
USDA MyPyramid,

DASH Diet Eating Plan

Healthy

way of eating,
Flexible enough to meet the
lifestyle and food preferences
of most people

Metabolic Syndrome- p. 442

Combination

of metabolic derangements

Leading

to increased risk of developing

cardiovascular disease and type 2 diabetes.
(both diseases)

Affects

one in five people in the United States

Prevalence

increases with age. Used to be

associated with middle age

Metabolic Syndrome,
continued
Multiple

metabolic derangements:

1. Fasting high blood sugar w/ insulin resistance

2. Dyslipidemia (Low HDL, High LDL & Triglycerides)

3. Hypertension
4. Abdominal Obesity

Metabolic Syndrome, NCEP

Requires at least 3 of these for the diagnosis
Central

obesity: waist circumference

40inches (male), or >36inches(female)
Dyslipidemia:

TG 150mg/dl

Dyslipidemia:

HDL-C < 40mg/dL (male)

< 50mg/dL (female)
Blood

pressure 130/85 mmHg

Fasting

blood glucose (110mg/dl)

People can develop

Metabolic Syndrome
without a high body
mass index (BMI)Butthis is rare

Apple Shape

Visceral Fat

Viscera The cavity that holds the organs is

called the visceral cavity and those are the
visceral organs.

The visceral organs are buried in visceral fat".

The fat literally encrusts the vital organs, the

kidneys, liver, stomach, and others.

Visceral Fat
Fat

cells of visceral fat increase inflammation in

the cells of organs (liver and pancreas) which
leads to

The

increase in adipose tissue also increases the

number of immune cells present, which play a
role in inflammation.

Chronic

inflammation increases the risk of

hypertension, diabetes and atherosclerosis

How to assess visceral fat

Best way is by a CAT scan or an MRI

This is not practical

Waist Circumference is an indication of central

obesity or extra visceral fat

Waist circumference is a marker of impaired

glucose tolerance and is a risk factor for
cardiovascular disease

Disease Risk Related to Weight and Waist Circumference

BMI
(kg/m2)

Obesit
y
Class

Men <40 WC Men >40 WC

Women
<35WC

Women >35
WC

Underweight

< 18.5

Normal

18.524.9

Overweight

25.029.9

Increased

High

Obesity

30.034.9 I

High

Very High

35.039.9 II

Very High

Very High

40.0 +

Extremely
High

Extremely High

Obesity
Extreme
Obesity

III

Visceral fat contributes to HTN by squeezing the

kidneys and wearing them out.
Visceral fat drains directly into the liver where it
infiltrates, replacing functional tissue with fat.

Fatty liver" exists in ~one-third of adults. Fatty

liver can lead to cirrhosis.(NASH or NAFLD)

http://health.usnews.com/he
alth-news/health-wellness/a
rticles/2013/10/17/what-isfatty-liver-and-how-do-youknow-if-you-have-it

Increasing Omega-3 Fatty Acids

Increasing Omega-3 Fatty Acids: DHA and EPA

Alpha-Linolenic

[ALA]

Acid

Flax oil & seeds

Walnuts
Canola and Soy oil
Small amounts of EPA
and DHA- (conversion
less efficient in men)

EPA and DHA reduce

inflammation [chronic
disease risk]

Eicosapentaenoic

Acid

[EPA] (oily fish)

Healthy blood
vessels

Docosahexaenoic
Acid [DHA] (oily fish)
Brain cell function

Gastrointestional
Integrity
Healthy

Intestinal Mucosa

Absorbs
Barrier

& assimilates food

vs. Pathogens/Antigens

Gastrointestinal

tract is the largest

immune organ in our bodies

PROBIOTICS AND PREBIOTICS

Beneficial

bacteria
naturally inhabit intestinal tract

Favorably

alter gut bacteria (flora)

Dependent

on bacteria-producing
food in diet called prebiotics

Gastrointestional
Integrity
Balanced

Intestinal Microflora
[Bacteria or Probiotics]
colon

= balance of beneficial &

pathogenic bacteria

Modification of bacterial populations can

affect immunity and digestion
Prebiotics

_____________________________
Probiotics _____________________________

http://www.npr.org/blogs/the
salt/2012/07/09/156381323/co
nfusion-at-the-yogurt-aisletime-for-probiotics-101

PROBIOTICS

Probiotics are found in bacteria-producing foods or

foods to which bacteria have been added
Yogurt,

kefir, acidophilus milk,

buttermilk, tempeh, miso, kimchi,
sauerkraut, and other fermented foods.

Yogurt -must contain active

cultures variety of cultures
is better

Not Just Any Bacteric Will Do!

Strains

Quantity

(CFUs)

Overstated Product Claims

Probiotics- Colony Forming Units (CFUs)

Probiotic numbers: measured in CFUs

Recommendations:

daily dose of at least 1

billion CFUs for health benefits.

Many probiotics products have more a

Consumer Reports review found yogurts and
yogurt drinks contain (and not all yogurt
does you have to read the label) between
15 and 155 billion CFUs per serving.

Effective Probiotic SupplementsSupplements, which usually come in capsule or powder

form, provide between 20 and 70 billion CFUS per daily
dose

Probiotics are not all the same

in effectiveness or function

Examples:

Bifidobacterium

infantis might help with IBS in

adults: regulates diarrhea/constipatio(AGA)

Lactobacillus
L.

GG- bacterial diarrhea in children

Reuteri- colic in infants

What the science says

Understanding probiotics & their potential for preventing/treating

health conditions is at an early stage

National Center for Complementary and Alternative Medicine

and
the American Society for Microbiology reviewed studies.

Uses of probiotics for which there is some encouraging

evidence:

treat diarrhea (best evidence, especially for diarrhea from

rotavirus in young children)

prevent & treat infections of the urinary or vaginal tract

treat irritable bowel syndrome

reduce recurrence of bladder cancer

shorten the time of some intestinal infections

Prevent/treat pouchitis (happens after surgery to remove the

colon)
Prevent and manage atopic dermatitis (eczema) in children

Long-Term harm from alcohol

Long-term fatty liver: due to slowing of the rate at

which the liver breaks down and removes fat.

Cirrhosis=Permanent scarring of the liver

.

Womens Health:
Osteoporosis
Osteoporosis
Most

susceptible 6-8 yrs postmenopause

http://www.spineuniverse.com/conditio

ns/osteoporosis/osteoporosis-animatio
n

Bone

Animation Video

Lifestyle Changes to Manage Chronic Disease

Behavior Change Theories

1. The Social Learning
Theory [Bandura] :
people learn from one
another, via observation,
imitation, and modeling.

Behavior Change Theories

2.Transtheoretical Model For Change
[Prochaska]
Focuses on persons decision making
Stages of Change

Motivational Interviewing

Motivational Interviewing
Counseling technique
Helps

people move ahead through the

Stages of Change
Ultimate
The

goal is pt. self mgt.

opposite of telling people what to do

Adherence vs. compliance

Initially Developed for

Smoking Cessation
Basis is that an
unhealthy behavior can
be rewarding for a
person

MI Definition

A collaborative,
person-centered form of
guiding
to elicit and strengthen
motivation for change
Motivation, not
persuading

Collaboration
Nonauthoritarian,partneringstyle
Workingtogether,notagainstoneanother
Elicitingwhats

importanttoclients from

theirviewpoint
Clientastheexpert

[about himself]

Explicitlyrecognizingthattheclientwillexercis

echoice
Supportingandaffirmingpersonalresponsibility

Non-Authoritarian
Ask Permission:
Id like to talk with you about ways you
could increase the amount of fruits you
eat.
Would that be alright with you?

MI Counseling Skills
1. Centeredontheperson and
honoringautonomy
2. Goaloriented andspecific
3. Guided conversations
4. Brief- suitable forshortcontactsessions

Who does the talking???

The

client should be
talking more than the
counselor

Useful,

guided
conversation

The more someone

talks about change,
the more likely they
are to change.

Change Talk OARS

Open

Ended Questions

Affirmations
Explorations
Summary

Exploration
Explore ambivalence:

On the one hand, you say you feel

great after you work out at the gym.
On the other hand, you are really
tired after work and you just want to
go home and have a beer and relax
instead of driving to the gym.

Find the Hooks

Affirm what the person is
doing right.
Ex. Im so glad you have
been walking for 30 minutes
every Sunday

Assess Motivation
You told me that your doctor
advised that you stop eating out
so often. On a scale of 1-10, how
motivated are you to follow her
advice?
Im really glad to hear that you
are a 3. Why not a 1?

Reference Book
Motivational Interviewing in Health Care
Rollnick and Miller

In-Class Activity
Using

MI Schematic, develop one for

Case Study: Alex

http://www.youtube.com/watch?v=Pwu9

9NIGiXU
10

minute video