# Presentation: 522116

## Dietary Guidelines for Americans – 2005: Focus on Older Adults

**Sheldon Gordon, MS, RD, LD**
**NCSFPA Workshop**
**March 1, 2007**

## Dietary Guidelines for Americans -The Process

- Direction for all federal nutrition programs
- Mandated every five years
- In 2005 contained stage of life, age-specific key recommendations

## Dietary Guidelines for Americans –The Purpose

- Health Promotion
- Disease Prevention

## Reasons for Specifying Recommendations for Older Adults

- Differences in requirements for specific nutrients
- Physiological changes that affect nutrient absorption, utilization, or excretion
- Lifestyle factors that affect nutrient intake or synthesis
- Higher risk for certain conditions/diseases
- Functional decline

## Focus Areas with Key Recommendations for Older Adults

## Adequate Nutrients Within Calorie Needs

- Consume variety of nutrient-dense foods and beverages.
- Choose foods that limit intake of saturated and *trans* fats, cholesterol, added sugars, salt, and alcohol.
- Adopt balanced eating pattern such as USDA Food Guide or DASH Eating Plan.
*Nutrients of concern for adults:                                   calcium, potassium, fiber,                                   magnesium, and vitamins A                                              (as carotenoids), C, and E.*

## Adequate Nutrients Within Calorie Needs: People over Age 50

*Increased risk for B**12** deficiency*
*Dietary intake adequate, but decreased                       ability to absorb vitamin B**12** *
*Decreased gastric acid*
*Interference by bacteria*
*Reduction in intrinsic factor*

**Consume vitamin B12 in its crystalline**
**form (i.e., fortified foods or supplements).**

## Adequate Nutrients Within Calorie Needs: Older Adults

*Limited sun exposure among frail older persons*
*Less conversion to vitamin D in skin*
*High risk for low serum 25(OH)D**3*
*Low intake of dairy foods*
*High risk of osteoporosis *
*May need up to 25 **μ**g per day*

*AJCN* 2004;80(suppl):1763S-1766S.

**Consume extra vitamin D from vitamin D-fortified foods and/or supplements.**

## Vitamin D in Your Diet 

- 3 cups fortified low-fat milk:	  7.5 μg
- 2 cups fortified orange juice:	  2.5 μg
- Supplemental vitamin D:		15.0 μg

*Dietary Guidelines for Americans – 2005*
*AJCN *2004;80(suppl):1763S-1766S
*Family Econ Nutr Rev*. 2003;15(1): 85-91

**It’s possible to get to 25 μg in your diet by consuming. . .**

## Physical Activity

- Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and maintain a healthy body weight.
- To achieve physical fitness include cardiovascular conditioning, stretching exercises
- 	for flexibility, and resistance
- 	exercises or calisthenics for
- 	muscle strength and endurance.

## Physical Activity: Older Adults

*Functional decline related to aging include:*
*Decreased muscle mass*
*Decreased strength*
*Increase in joint dysfunction                                                  and arthritis*

*AJCN* 2005;82:923-34

**Participate in regular physical activity to help reduce decline mobility associated with aging and to achieve the other health benefits of physical activity identified for all adults.**

## Sodium and Potassium

- Consume less than 2,300 mg of sodium per day (approximately 1 teaspoon).
- Choose and prepare foods with little salt.
- Reducing blood pressure reduces
- 	risk of stroke, heart disease,
- 	heart failure, and kidney disease.

## Sodium and Potassium:Older Adults

*Higher risk for hypertension.*
*Tend to be more salt sensitive.*
*Check with health care provider                               before using salt substitute.*

**Aim to consume no more than 1,500 mg of **
**sodium per day, and meet the potassium **
**recommendation  (4,700 mg/day) with food.**

## Food Safety

- CLEAN: Wash hands and surfaces often
- SEPARATE: Don't cross-contaminate
- COOK food to proper temperatures
- CHILL Refrigerate Promptly

## Food Safety: Older Adults

- Do not eat or drink unpasteurized milk or any products made from raw milk milk or partially cooked eggs...
- Higher risk for foodborne illnesses
*Medication use*
*Chronic illnesses*
*Smell and taste deficits*
*Cognitive impairment*
- More likely to get very sick
- 	when contracting foodborne illness.

## Weight Management

- To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended.
- To prevent gradual weight
- 	gain over time, make small
- 	decreases in food and                          beverage calories and
- 	increase physical activity.

## Slide 17

## Older Americans Update 2006: Key Indicators of Well-Being. 

*Older Americans Update 2006: Key Indicators of Well-Being*.
- _http://www.agingstats.gov/update2006/pressroom.html_

## Weight Management:Overweight Adults ... with Chronic Diseases and/or on Medication

*Older adults more likely to have                                     one or more chronic diseases*
*Older adults more likely to take                          medication, particularly multiple                         medications.*
*Weight management a concern                                among older adults.*

**Consult a health care provider before starting a weight-reduction or exercise program.**

## Medical Complications Associated with Obesity in Older Adults

- Metabolic syndrome
- Osteoarthritis (knee)
- Obstructive sleep apnea
- Urinary incontinence
- Cataracts
- Cancer
- Decline in physical function

*AJCN* 2005;82:923-34

## Weight Loss in Older Adults

- Improves physical function and health-related quality of life.
- Can decrease muscle and bone mass.
- Include aerobic and resistance exercise.
- Encourage adequate calcium and vitamin D intake.
- Older adults may be more compliant in a targeted lifestyle intervention (e.g., DPP).

*AJCN* 2005;82:923-34

## So What Do We Do Next? 

## Slide 23

## Activity
Moderation
Personalization
Proportionality
Variety
Gradual Improvement

- Activity
- Moderation
- Personalization
- Proportionality
- Variety
- Gradual Improvement

- MyPyramid

## MyPyramid Food Intake Pattern Calorie Levels

**Activity level Sedentary*     Mod. active* ****	****         Active***
**AGE**
**51-55 ****	****           2200                2400 ****	****         2800 ****	****	**
**56-60 ****	****           2200                2400                        2600 **
**	**
**61-65                2000                2400                        2600 ****	****	**
**66-70                2000                2200                        2600**** ****	****	**
**71-75                2000                2200                        2600 ****	****	**
**76 +                  2000                2200                        2400 ****	****	**

## MyPyramid Food Intake Pattern 

**Activity level ****	****Sedentary* ****	****Mod. active* ****	****Active***
**AGE**
**51-55 ****	****	****1600 ****	****	****1800 ****	****	****2200**
**56-60 ****	****	****1600 ****	****	****1800 ****	****	****2200**
**61-65 ****	****	****1600 ****	****	****1800 ****	****	****2000**
**66-70 ****	****	****1600 ****	****	****1800 ****	****	****2000**
**71-75 ****	****	****1600 ****	****	****1800 ****	****	****2000**
**76 +    ****	****	****1600 ****	****	****1800 ****	****	****2000**

- MyPyramid Food Intake Pattern
- Calorie Levels

## Daily Amount of Food from Each Group

| Calorie level | 1600 | 1800 | 2000 | 2200 | 2400 | 2600 |
| --- | --- | --- | --- | --- | --- | --- |
| Fruits | 1.5 cups | 1.5 cups | 2 cups | 2 cups | 2 cups | 2 cups |
| Vegetables | 2 cups | 2.5 cups | 2.5 cups | 3 cups | 3.5 cups | 3.5 cups |
| Grains | 5 oz-eq | 6 oz-eq | 6 oz-eq | 7 oz-eq | 8 oz-eq | 9 oz-eq |
| Meat & beans | 5 oz-eq | 5 oz-eq | 5.5 oz-eq | 6 oz-eq | 6.5 oz-eq | 6.5 oz-eq |
| Milk | 3 cups | 3 cups | 3 cups | 3 cups | 3 cups | 3 cups |
| Oils | 5 tsp | 5 tsp | 6 tsp | 6 tsp | 7 tsp | 8 tsp |
| Discretionary 
Calorie 
Allowance | 132 | 195 | 267 | 290 | 362 | 410 |

## Whole Grains

- whole-wheat flour
- bulgur (cracked wheat)
- oatmeal
- whole cornmeal
- brown rice

## Refined Grains

- white flour
- degermed cornmeal
- white bread
- white rice

## Grains – How much?

**Women **  51+ years old
- 5 ounce equivalents
- 3 ounce equivalents of whole grains
**Men   **51+ years old
- 6 ounce equivalents
- 3 ounce equivalents of whole grains

## Whole Wheat Cereal Flakes — 1 Cup

**Grains Group:** counts as 1 ounce equivalent whole grains

## Vegetables

- Women, 51+
- 2 cups
- Men, 51+
- 2 1⁄2 cups

## Fruits

- Women, 51+
- 1 1⁄2 cups
- Men, 51+
- 2 cups

## Meat and Beans

- Women, 51+
- 5 ounce-equivalents
- Men, 51+,
- 5 1⁄2 ounce-equivalents

## Milk

- Women, 51+
- 3 cups
- Men, 51+
- 3 cups

## Oils

- Women, 51+
- 5 teaspoons
- Men, 51+
- 6 teaspoons

## Fats and their bonds

**Carbon-Carbon**** Single Bond**

- Saturated fatty acid/hydrogenated fats

- Unsaturated fatty acid

**Carbon-Carbon     Double Bond**

## Trans Fats

***	******Trans***** Fat****	****(i.e., *****trans***** fatty acids)**

- Cis fatty acids

## Trans fats in food supply

## Discretionary Calories

- Women, 51+
- Calorie levels from 1600-2200
- “Extras” can equal 132-290 calories
- Men, 51+
- Calorie levels from 2000-2600
- “Extras” can equal 267-410 calories

## Commodities That Can Help

## Commodities That Can Help

## Resources and References

*DG Advisory Committee Report*: _www.health.gov/dietaryguidelines/dga2005/report_
*DG for Americans*: _http://healthierus.gov/dietaryguidelines_
*Facts about the DASH Eating Plan*: _www.nhlbi.nih.gov/health/public/heart/hbp/dash_
*Behavioral Risk Factor Surveillance System*: _www.cdc.gov/brfss _
- Food safety information: _www.foodsafety.gov_
- Kennedy ET. Evidence for nutritional benefits in prolonging wellness.     *AJCN* 2006;83(suppl): 410S-414S.
- Villareal DT et al. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. *AJCN* 2005;82:923034.
- Dawson-Hughes B. Racial/ethnic considerations in making recommendations for vitamin D for adult and elderly men and women. *AJCN* 2004;80(suppl):1763S-1766S.