Handbook of Clinical Nutrition and Aging (eBook)

HANDBOOK OF CLINICAL NUTRITION AND AGING 2
Dedications 6
Acknowledgements 7
Series Introduction 8
Foreword 15
Preface 17
Contents 19
Contributors 22
Part I: Over-Arching Issues For Nutritional Well-Being in Late Life 25
An Ecological Perspective on Older Adult Eating Behavior 26
1.1 Introduction 26
1.2 Intrapersonal Level 28
1.2.1. Intervention Strategies at the Intrapersonal Level 29
1.3 Interpersonal Level 30
1.3.1. Intervention Strategies at the Interpersonal Level 31
1.4 Institutional Level 31
1.4.1. Intervention Strategies at the Institutional Level 33
1.5 Community Level 33
1.5.1. Intervention Strategies at the Community Level 34
1.6 Policy Level 34
1.6.1. Interventions Targeted at the Policy Level 36
1.7 Implications of an Ecological Approach and Opportunities for Intervention 36
1.8 Recommendations 37
References 37
Behavioral Theories Applied to Nutritional Therapies for Chronic Diseases in Older Adults 41
2.1 Introduction 41
2.2 Benefits of Behavioral Theories in Practice 42
2.3 Overview of Common Behavioral Theories/Models Used in Nutrition Interventions for Older Adults 42
2.3.1. Social Ecologic Theory or the Ecological Perspective 42
2.3.2. The Health Belief Model 43
2.3.3. Stages of Change 43
2.3.4. The Theory of Meaningful Learning 43
2.3.5. The Information Processing Model 43
2.3.6. Social Cognitive Theory 45
2.4 Examples of Nutrition Interventions Grounded in Behavioral Models 45
2.4.1. Diabetes Mellitus 45
2.4.2. Hypertension 47
2.4.3. Heart Failure 48
2.4.4. Hyperlipidemia 48
2.4.5. Cardiovascular Disease Prevention 48
2.4.6. Diet Quality 49
2.5 Practical Applications of Behavioral Theory in Dietary Interventions for Older Adults 49
2.6 Recommendations 52
References 52
Global Graying, Nutrition, and Disease Prevention: An Update on China and Future Priorities 54
3.1 Introduction to the Challenge 54
3.2 Global Life Expectancy Trends 56
3.3 Profile of Global Mortality and Morbidity Causes 58
3.4 Interactions of Health Behaviors With Expected Morbidity and Mortality 60
3.5 Cross-Cultural Issues: Focus on China 61
3.6 China: Update on Transitions in Diet and Disease Patterns 62
3.6.1 Changes in Dietary Patterns 62
3.6.2 Changes in Disease Patterns and Prevalences 63
3.6.2.1 Obesity 64
3.6.2.2 Hypertension 65
3.6.2.3 Type 2 Diabetes (T2D) 65
3.7 Rapid Growth of the Elderly Population in China 66
3.7.1 Prolonged Life and Changes of Population Structure 66
3.7.2 Nutritional Status and Health Behaviors of Chinese Older Adults 68
3.7.2.1 Cigarette Smoking 68
3.7.2.2 Alcohol Consumption 69
3.7.2.3 Physical Activity Behaviors 70
3.7.3 Causes of Death, Illness, and Disability in Older Chinese Adults 72
3.7.3.1 Leading Causes of Death 72
3.7.3.2 Special Concerns About Alzheimer’s Disease and Quality of Life 73
3.7.3.3 Other Risk Factors for Poor Health-Related Quality of Life 73
3.8 Traditional Views of Aging in China: A Positive Model But Concerns For the Future 74
3.9 Coming Challenges for Social Services and the Health Care System in China 76
3.9.1 Medical and Economic Impact of a Graying Population 76
3.9.2 Public Health Responses 76
3.10 Implementation of Preventive Nutrition: Global Implications 77
3.10.1 Achieving Global Behavior Change in Older Adults 77
3.10.2 Soaring Global Food Costs and the Dual Challenge of Under- and Over-Nutrition 78
3.10.3 Summary 79
3.11 Recommendations 80
References 80
Part II: Fundamentals of Nutrition and Geriatric Syndromes 84
Update on Nutritional Assessment Strategies 85
4.1. Introduction 85
4.2. Body Mass as an Indicator of Nutritional State 86
4.3. Nutritional Questionnaires 87
4.4. Assessment of Dietary Intake 90
4.5. Anthropomorphic Measures 90
4.6. Utility of Serum Protein, Cholesterol and Hemoglobin 90
4.7. Dehydration 91
4.8. Immune Assessment and Nutrition 91
4.9. Assessing Frailty, Strength and Mobility 91
4.10. Assessing Disability 92
4.11. Screening For Osteoporosis 92
4.12. Measurements of Vitamins and Trace Elements 93
4.13. Recommendations 93
References 94
Sensory Impairment: Taste and Smell Impairments with Aging 96
5.1 Introduction 96
5.2 Taste 97
5.2.1 Taste Losses at Threshold Levels 98
5.2.2 Suprathreshold Taste Perception 105
5.2.3 Medications and Medical Conditions Associated with Taste Alterations 105
5.3 Smell 107
5.3.1 Perceptual Olfactory Losses in Older Persons 108
5.3.2 Causes of Olfactory Losses in Older Persons 108
5.4 Other Age-Related Sensory Losses 109
5.4.1 Vision 109
5.4.2 Auditory System 110
5.4.3 Somatosensory System with Age 111
5.5 Challenges For Assessing Sensory Functioning in Older Persons: Comparison of Taste and Smell With Other Senses 111
5.6 Final Comment 114
5.7 Recommendations 114
References 115
Nutrition and the Aging Eye 117
6.1 Introduction 117
6.2 Physiological Basis of Cataracts and AMD 118
6.3 Human Studies on Dietary Intake and Blood Levels of Antioxidants and Eye Disease 120
6.3.1. Cataract 120
6.3.1.1. Vitamin C 120
6.3.1.2. Vitamin E 121
6.3.1.3. Lutein and Zeaxanthin 122
6.3.1.4. Omega-3 Fatty Acids 123
6.3.2. AMD 124
6.3.2.1. Vitamin C 124
6.3.2.2. Vitamin E 125
6.3.2.3. Lutein and Zeaxanthin 125
6.3.2.4. Omega- 3 Fatty Acids 126
6.3.2.5. Zinc 127
6.4 The Effect of Nutrient Supplements on Eye Disease Risk 129
6.4.1. Cataract 129
6.4.2. AMD 131
6.5 Clinical Summary And Treatment Guidelines 132
6.6 Conclusion 135
References 135
Common Gastrointestinal Complaints in Older Adults 139
7.1 Introduction 139
7.2 Dysphagia 140
7.3 Gastroesophageal Reflux Disease (Gerd) and Heartburn 141
7.4 Gastritis and Peptic Ulcer Disease 143
7.5 Diarrhea 144
7.5.1 Infectious Gastroenteritis 144
7.5.2 Drug-Induced Diarrhea 145
7.6 Other Gi Disorders 145
7.6.1 Fecal Impaction 145
7.6.2 Ischemic Colitis 145
7.6.3 Inflammatory Bowel Disease 146
7.6.4 Microscopic Colitis 146
7.6.5 Small Bowel Bacterial Overgrowth 146
7.6.6 Lactose Intolerance 147
7.6.7 Incontinence 147
7.6.8 Constipation 148
7.7 Gastrointestinal Bleeding 149
7.8 Hepatitis 150
7.9 Anemia 151
7.10 Recommendations 152
References 152
Hydration, Electrolyte, and Mineral Needs 155
8.1 Introduction 155
8.2 Dehydration and Hypernatremia Due to Primary Water Loss 157
8.3 Sodium 158
8.3.1 Hyponatremia with Contracted ECFV 159
8.3.2 Hyponatremia with Expanded ECFV (Dilutional Hyponatremia) 161
8.3.3 Hyponatremia with Normal ECFV (Syndrome of Inappropriate ADH) 161
8.4 Potassium 162
8.4.1 Hypokalemia 162
8.4.2 Hyperkalemia 164
8.5 Calcium 164
8.5.1 Hypocalcemia 165
8.5.2 Hypercalcemia 166
8.6 Magnesium 166
8.6.1 Magnesium Deficiency (Hypomagnesemia) 167
8.6.2 Hypermagnesemia 167
8.7 Trace Minerals 168
8.7.1 Zinc 168
8.7.2 Copper 169
8.7.3 Iron 170
8.7.4 Selenium 170
8.7.5 Chromium 171
8.7.6 Manganese 171
8.7.7 Molybdenum 171
8.7.8 Other Trace Minerals 172
8.8 Recommendations 172
References 173
Redefining Nutritional Frailty: Interventions for Weight Loss Due to Undernutrition 174
9.1 Nutritional Frailty: A Revised Definition Based on Etiology 174
9.1.4. Definitions and Risk Factors 175
9.1.4. The Mortality Impact of Body Weight and Weight Loss 176
9.2 Causes of Undernutrition 177
9.3 Early Interventions to Increase Food and Fluid Intakes 178
9.3.1. Therapeutic Interventions 178
9.3.2. Improving the Dining Environment and the Nutritional Value of Food Choices 179
9.3.3. Providing Feeding Support and Assistance 180
9.3.4. Use of Appetite Stimulants (Orexigenic Agents) 182
9.4 Intervention With Nutritional (Protein/Calorie) Supplements 185
9.5 Partial or Total Nutrition Support 192
9.6 Recommendations 194
REFERENCES 194
Sarcopenia 200
10.1 Introduction 201
10.2 Definition of Sarcopenia 201
10.3 Process of Sarcopenia 201
10.4 Classification and Prevalence of Sarcopenia 202
10.5 Influence of Sarcopenia on Strength, Functional Impairment, Morbidity, and Mortality 202
10.5.1 Changes in Strength 203
10.5.2 Functional Impairment and Physical Disability 203
10.5.3 Morbidity 210
10.5.4 Mortality 211
10.6 Age-Related Changes in Skeletal Muscle Composition 211
10.7 Prevention and Treatment of Sarcopenia 212
10.8 Summary and Conclusions 217
10.9 Recommendations 217
References 218
Cachexia: Diagnosis and Treatment 223
11.1 Introduction 223
11.2 Causes and Mechanisms of Cachexia 225
11.2.1 Mechanisms of Cachexia 226
11.3 Consequences of Cachexia 227
11.4 Age-Related Changes in Pro-Inflammatory Cytokines 227
11.5 Distinguishing Cachexia From Starvation 228
11.6 Interventions for Cachexia 230
11.7 Recommendations 230
REFERENCES 231
The Relationship of Nutrition and Pressure Ulcers 234
12.1 Introduction and Background 234
12.2 Epidemiological Associations of Nutrition and Pressure Ulcers 235
12.3 Nutrition in the Prevention of Pressure Ulcers 236
12.4 Nutrition in the Healing of Pressure Ulcers 239
12.5 General Nutritional Support for Persons with Pressure Ulcers 240
12.5.1 Energy 240
12.5.2 Protein 240
12.5.3 Amino Acids 241
12.5.4 Vitamins and Minerals 241
12.6 Factors Contributing to the Nutritional Paradox 242
12.7 Interventions for Inflammatory-Mediated Cachexia 244
12.8 Conclusions 245
12.9 Recommendations 245
References 245
Nutrition at the End of Life: Ethical Issues 250
13.1 Introduction 250
13.2 Definitions 251
13.3 Legal, Religious And Ethical Precidents For Decision-Making 251
13.4 Nutrition And Hydration In Advanced Illness 252
13.4.1 Artificial Nutrition and Hydration in Terminal Cancer 252
13.4.2 Artificial Nutrition and Hydration in Terminal Dementia 253
13.4.2.1. Definitions and Prognosis of Advanced Dementia 253
13.4.2.2. Addressing the Costs and Benefits of Artificial Nutrition and Hydration in Advanced Dementia 254
13.4.2.3. Alternative Approaches to Artificial Nutrition and Hydration in Advanced Dementia 254
13.5 Addressing Treatment Goals And Decision-Making For Terminal Patients 255
13.6 Practical Considerations Before Providing Enteral/Parental Nutrition And Hydration 256
13.7 Summary 257
13.7.1 Recommendations 257
References 258
Part III: Common Clinical Conditions 260
Nutrition and Oral Health: A Two-Way Relationship 261
14.1 Oral Health Status in Older Adults 261
14.1.3. Common Oral Conditions in Older Adults 262
14.1.1.1. Dental Caries, Periodontal Disease and Tooth Loss 262
14.1.1.2. Oral Cancer 262
14.2 Impact of Nutritional Status on Oral Health 263
14.2.1. Plaque and Calculus Formation 263
14.2.2. Dental Caries 264
14.2.3. Chronic Periodontitis 264
14.2.4. Oral Cancer 266
14.2.4.1. Fruits and Vegetables 266
14.2.4.2. Anti-Oxidants and Other Micronutrients 266
14.2.4.3. Other Food and Nutrients 267
14.3 Impact of Oral Health on Nutrition 267
14.3.1. Impact of Tooth Loss on Nutritional Status 267
14.3.2. Impact of Oral Cancer on Nutrition 270
14.3.3. Impact of Xerostomia on Nutrition 270
14.4 Conclusion 271
14.5 Recommendations 272
References 272
Obesity in Older Adults - A Growing Problem 277
15.1 Introductory OvervieW 277
15.2 Obesity: an Epidemic 278
15.3 Pathophysiology of Obesity 278
15.4 Measuring Overweight and Obesity 279
15.4.1. Body Mass Index 279
15.4.2. Waist Circumference 280
15.5 Health Implications of Obesity 280
15.5.1. Adverse Effects of Obesity 280
15.5.1.1. Mortality 280
15.5.1.2. Comorbid Disease 280
15.5.1.3. Metabolic Abnormalities 280
15.5.1.4. Arthritis 281
15.5.1.5. Pulmonary Abnormalities 281
15.5.1.6. Urinary Incontinence 281
15.5.1.7. Cancer 282
15.5.1.8. Functional Impairment and Quality of Life 282
15.5.2. Beneficial Effects of Obesity 283
15.6 Effects of Weight Loss in Older Adults 284
15.6.1. Body Composition 284
15.6.2. Medical Complications 284
15.6.3. Physical Function and Quality of Life 284
15.6.4. Mortality 284
15.6.5. Bone Mineral Density 285
15.7 Interventions and Treatment 285
15.7.1. Lifestyle Intervention 285
15.7.1.1. Diet Therapy 285
15.7.1.2. Physical Activity 287
15.7.1.3. Behavior Modification 287
15.7.2. Pharmacotherapy 287
15.7.3. Weight-Loss Surgery 288
15.8 Conclusion 288
REFERENCES 288
Nutrition and Lifestyle Change in Older Adults with Diabetes Mellitus and Metabolic Syndrome 292
16.1 Diabetes in Older Us Adults 293
16.2 Health Consequences of Diabetes 294
16.3 General Aims of Diabetes Treatment 294
16.4 Diagnosis and Classification 294
16.4.1. Diagnosis 294
16.4.2. Typologies of Diabetes in Older Adults 295
16.4.2.1. Type 1 Diabetes 295
16.4.2.2. Type 2 Diabetes 295
16.5 Establishing Medication and Nutritional Management Goals 296
16.5.1. Medication Use and Glycemic Control in Older Adults with Diabetes 296
16.5.1.1. Goals of Diabetes Treatment in Older Adults 296
16.5.1.2. General Diabetes Dietary Recommendations 299
16.5.1.3. Balancing Diet and Medication 301
16.6 Body Weight and Functional Status in Older Adults with Diabetes 301
16.6.1. Overweight and Obesity 301
16.6.2. Underweight and Malnutrition 302
16.7 Special Nutrition Intervention Situations for Persons with Diabetes 302
16.7.1. Acute Illness, Hospitalization, Enteral and Parenteral Nutrition 302
16.7.2. Hospitalization 303
16.7.3. Enteral and Parenteral Nutrition 303
16.7.4. Long-Term Care 304
16.8 Metabolic Syndrome 304
16.9 Hypoglycemia in Older Adults 307
16.9.1. Self-Monitoring and Dietary Treatment of Hypoglycemia 307
16.9.2. Hypoglycemia Unawareness and Treatment of Hypoglycemia 308
16.10 Diabetes Lifestyle Change and Physical Limitations 309
16.11 Self-Management Behaviors 310
16.11.1. Considering Diabetes Self-Management and Dietary Guidelines Within the Context of Older Adults’ Lives 311
16.11.2. Dietary Habits of Older Adults with Diabetes 311
16.12 Psychosocial and Behavioral Issues Related to Self-Care and Dietary Intake in Older Adults with Diabetes 312
16.12.1. Depression 312
16.12.1.1. Depression and Dietary Intake in Older Adults 313
16.12.1.2. Depression Intervention in Diabetes 313
16.12.2. Social Support 314
16.12.3. Cognitive Dysfunction 315
16.12.4. Attitudes and Dietary Intake in Older Adults with Diabetes 316
16.12.5. Ethnic/Cultural Issues Influencing Self-Care and Dietary Intake 317
16.12.6. Quality of Life and Diabetes Diet in Older Adults 319
16.13 Theoretical Conceptualizations of Lifestyle Change in Older Adults with Type 2 Diabetes 320
16.14 Behavior Change Intervention Studies of Self-Management and Lifestyle Change in Older Adults with Diabetes 320
16.14.1. Diet-Specific Intervention in Older Adults with Diabetes 321
16.14.2. Weight Loss Intervention in Older Adults with Diabetes 322
16.15 Recommendations for Imparting Dietary Information 323
16.16 Recommendations 324
16.1 Appendix 324
16.1.2. Internet Resources 324
REFERENCES 325
Cardiac Rehabilitation: The Nutrition Counseling Component 331
17.1 Core Components of Cardiac Rehabilitation 331
17.2 Nutrition and Cardiovascular Risk 332
17.3 Special Issues of Concern for Older Patients in Cardiac Rehabilitation 333
17.4 Dietary Intake and the Management of Heart Disease 335
17.4.1 Fruits and Vegetables 335
17.4.2 Dietary Fats 336
17.4.3 Dairy Products 337
17.4.4 Whole Grains and Starches 338
17.5 Additional Relevant Dietary Components 338
17.5.1 Stanols and Sterols 338
17.5.2 Alcohol 339
17.5.3 Sodium 339
17.6 Alternative Dietary Patterns 339
17.7 Recommendations for Appropriate Caloric Intakes and Dietary Patterns 340
17.8 Summary 341
17.9 Recommendations 341
References 343
Chronic Heart Failure 345
18.1 Overview of Heart Failure 345
18.1.1 Background 345
18.1.2 Etiology 346
18.1.3 Pathophysiology 346
18.1.4 Clinical Features 347
18.1.5 Prognosis 347
18.1.6 Treatment 347
18.2 General Nutritional Aspects of Heart Failure 348
18.2.1 Heart Failure as a Metabolic Syndrome 348
18.2.2 Cardiac Cachexia 350
18.2.3 Caloric Intake, Fat, and Protein 351
18.2.4 Heart Failure and Obesity 352
18.3 Specific Nutrients in Heart Failure 352
18.3.1 Water and Sodium 352
18.3.2 Other Electrolytes 353
18.3.3 Other Minerals 354
18.3.4 Vitamins 355
18.3.5 Other Nutritional Supplements 356
18.3.6 Multinutrient Therapy 356
18.4 Impact of Heart Failure Medications and age on Nutritional Parameters 357
18.4.1 Medication Effects 357
18.4.2 Age-Specific Nutritional Issues 357
18.5 Nutritional Guidelines 358
References 361
Nutrition Support in Cancer 366
19.1 Introduction 366
19.2 Background 367
19.3 Physiologic Basis For Malnutrition in Cancer and Contributing Factors 368
19.4 Risk Factors For Malnutrition in Older Cancer Patients 370
19.5 Nutritional Assessment of Older Cancer Patients 371
19.6 Nutritional Support of Older Cancer Patients 373
19.6.1 Levels of Intervention 374
19.6.2 Tailoring the Intervention 376
19.7 Cancer Anorexia-Cachexia-Specific Interventions 377
19.8 Recommendations 379
References 379
Nutrition and Chronic Obstructive Pulmonary Disease 384
20.1 Introduction 385
20.2 Definition, Pathophysiology, and Etiology of Copd 386
20.3 Nutritional Concerns 387
20.3.1. Low Body Weight, Weight Loss, and Muscle Wasting in COPD 387
20.3.2. Causes of Weight Loss and Muscle Mass Depletion 388
20.3.2.1. Metabolic Disturbances 388
Hypermetabolism 388
Catabolic processes 389
Alterations in protein and amino acid metabolism 390
Hormonal alterations 390
Muscle dysfunction 391
20.3.2.2. Reduced Food Intake 391
Difficulties in shopping for food, meal preparation, cooking, and fatigue 391
Dyspnea, dysphagia, gastroesophageal reflux 392
Loss of appetite, taste alteration, and early satiety 392
Solitude, depression, and anxiety 393
Social norms, attitudes, and health beliefs 393
Hospitalization and treatment with glucocorticoids 393
20.4 Nutritional Evaluation of Depletion 394
20.4.1. Screening for Malnutrition 394
20.4.2. Assessment of Nutritional Status of Patients with COPD 395
20.4.3. Assessment of Visceral Protein Status 397
20.4.4. Assessment of Short-Term Changes in Lean Body Mass 397
20.5 Nutritional Intervention in Malnourished Stable Patients with Copd 397
20.5.1. Nutritional Intervention During an Acute Exacerbation 399
20.6 Nutrition and Exercise 399
20.7 What Are the Nutritional Requirements of Copd Patients? 399
20.7.1. Energy and Protein Intake 400
20.7.1.1. The Macronutrient Composition Of Food Intake 400
20.7.1.2. Amino Acids 400
20.7.1.3. Polyunsaturated Fatty Acids 400
20.7.1.4. Fruit And Vegetable Intake And Alcohol 401
20.8 Recommendations 401
20.8.1. Maintaining or Improving Nutritional and Respiratory Function 402
20.8.1.1. Role of The Dietitian 402
20.8.1.2. Maintaining or Improving Respiratory Function 403
20.9 Recommendations 404
REFERENCES 404
Nutrition and Chronic Kidney Disease 414
21.1 Introduction 414
21.2 Role of Diet and Obesity on Development and Progression of CKD 415
21.2.1 Salt Intake, Hypertension and the Risk of CKD 415
21.2.2 Protein Intake and Kidney Function 416
21.2.2.1 In those with Normal Renal Function 416
21.2.2.2 In those with Chronic Kidney Disease 416
21.2.3 Obesity, Insulin Resistance and the Risk of CKD 417
21.3 Nutritional ISSUES IN uremia 418
21.3.1 Obesity Paradox in Uremia 418
21.3.2 Pathophysiology of Malnutrition in Uremia 418
21.3.2.1 Protein Intake and Nutritional Status 419
21.3.2.2 Metabolic Acidosis and Nutritional Status 420
21.3.2.3 Inflammation and Nutritional Status 420
21.4 Calcium-Phosphorus, Parathyroid Hormone, and Vascular Calcification 421
21.5 Recommendations 421
References 422
Nutritional and Pharmacological Aspects of Osteoporosis 427
22.1. Bone Structure and Bone Mass During the Normal Life Cycle 428
22.2. Measurement of Bmd in the Diagnosis of Osteoporosis and Prediction of Fracture Risk 429
22.3. Etiologies and Types of Osteoporosis 430
22.4. Non-Dietary Risk Factors Implicated in Etiology of Osteoporosis 430
22.5. Dietary Risk Factors Implicated in Etiology of Osteoporosis 431
22.5.1. Calcium and Phosphorus 431
22.5.2. Vitamin D 432
22.5.3. Vitamin K 433
22.5.4. Protein and Acid Load 433
22.5.5. Sodium and Potassium 434
22.5.6. Phytochemicals, Micronutrients, and Other Bioactive Compounds 434
22.6. Adaptation to Low Calcium Intakes 435
22.7. Dietary Prevention and Treatment-Foods and Supplements 435
22.8. Adverse Effects of Excessive Calcium and Vitamin D Supplementation 436
22.9. Drugs and Other Agents Used in Prevention and Treatment of Osteoporosis 437
22.9.1. Anti-resorptive Agents 438
22.9.1.1. Calcium and Vitamin D 438
22.9.1.2. Active Metabolites of Vitamin D 439
22.9.1.3. Estrogens 439
22.9.1.4. Selective Estrogen Receptor Modulators (SERMs) 440
22.9.1.5. Isoflavones 440
22.9.1.6. Bisphosphonates 441
22.9.1.7. Calcitonin 441
22.9.1.8. Inhibitors of RANKL 441
22.9.2. Anabolic Agents 442
22.9.2.1. Sodium Fluoride 442
22.9.2.2. Parathyroid Hormone (PTH) 442
22.9.2.3. Growth Hormone and Insulin-Like Growth Factor-1 (IGF-1) 443
22.10. Summary 443
22.11. Recommendations 444
References 445
Osteoarthritis 449
23.1 Introduction 449
23.1.2 Risk Factors for Osteoarthritis 449
23.1.2 Pathogenesis of Osteoarthritis 450
23.1.2 Clinical Features of Osteoarthritis 451
23.1.2 Therapeutic Approach to Osteoarthritis 451
23.1.2 Osteoarthritis and Diet 451
23.2 Osteoarthritis and Nutritional Supplements 452
23.2.1 Glucosamine and Chondroitin Sulfate 452
23.2.1.1 Glucosamine 452
23.2.1.2 Chondroitin Sulfate 453
23.2.1.3 Sulfate 454
23.2.2 Efficacy for Pain and Function 455
23.2.3 Efficacy as Disease-Modifying Agents 459
23.2.4 Omega-3 Polyunsaturated Fatty Acids 460
23.2.5 Avocado/Soybean Unsaponifiables 461
23.2.6 Selenium and Iodine: Studies of Kashin-Beck Disease 461
23.2.7 Other Nutritional Products 463
23.3 Oxidative Damage and Osteoarthritis 463
23.3.1 Antioxidant Effects 464
23.3.2 Antioxidant Micronutrients in Osteoarthritis 464
23.3.2.1 Vitamin C 464
23.3.2.2 Vitamin D 468
23.3.2.3 Vitamin E 471
23.3.2.4 Vitamin K 473
23.4 Weight Loss 474
23.5 Recommendations 477
References 477
Post-stroke Malnutrition and Dysphagia 488
24.1 Introduction 488
24.2 Malnutrition Risk Factors Associated With Stroke 489
24.2.1 Malnutrition Due to Feeding Problems 489
24.3 Dysphagia as A Major Risk Factor for Malnutrition Following Stroke 491
24.3.1 Normal Swallowing and Age-Related Changes 491
24.3.2 Oropharyngeal Dysphagia 491
24.4 Approaches for Swallow Assessment: Cse, Vse, Fees 492
24.4.1 Clinical Swallow Evaluation 494
24.4.2 Instrumental Swallow Evaluations 495
24.4.2.1 Videofluoroscopic Swallow Evaluation (VSE) 496
24.4.2.2 Fiberoptic endoscopic Evaluation of Swallowing (FEES) 496
24.4.2.3 Functional Oral Intake Scale (FOIS) 496
24.5 Subjective Assessment of Swallowing 497
24.5.1 Dysphagia Disability Index and Reflux Symptom Index 497
24.5.2 Patient-Centered Quality-of-Life Outcomes Tools: SWAL-CARE and SWAL-QOL 497
24.6 Intervention Following Stroke 498
24.6.1 Pneumonia Costs 499
24.6.2 Pneumonia Prevention 499
24.6.3 Alternative Means of Nutrition 499
24.6.4 Dysphagia Intervention and Treatment 500
24.6.4.1 Thickened Liquids 500
24.6.4.2 Fluid Intake Maintenance 500
24.6.4.3 Frazier Free Water Protocol 500
24.6.4.4 Oral Hygiene Education 501
24.6.4.5 Dysphagia Exercises and Compensatory Maneuvers 501
24.7 Future Research 502
24.8 Recommendations 503
References 503
Alzheimer’s Disease and Other Neurodegenerative Disorders 507
25.1 Introduction 507
25.2 Pathophysiology of Neurodegenerative Disorders 508
25.2.1 Alzheimer’s Disease 508
25.2.2 Parkinson’s Disease 510
25.2.3 Amyotrophic Lateral Sclerosis 511
25.2.4 Huntington’s Disease 512
25.3 Nutritional Factors and the Risk of Ad and Other Neurodegenerative Disorders 513
25.3.1 Dietary Fat and Cholesterol 513
25.3.2 Dietary Carbohydrates and Glucose Tolerance 514
25.3.3 Vitamins and Antioxidants 515
25.3.3.1 Vitamins B6 and B12, Folate, and Homocysteine 515
25.3.3.2 Antioxidant Nutrients 517
25.3.4 Dietary Patterns 518
25.3.5 Caloric Restriction as a Preventative Strategy 519
25.3.6 Weight Loss in Neurodegenerative Disorders 519
25.4 Closing Remarks 522
25.5 Recommendations 522
References 523
Nutrition and Late-Life Depression 530
26.1 Introduction 530
26.1.2 Diagnosis of Depression 530
26.1.2 Impact of Depression 531
26.1.2 Etiology of Late-Life Depression 531
26.2 Energy Balance 533
26.2.1 Obesity 533
26.3 Dietary Fat 533
26.3.1 Omega-3 Fatty Acids 534
26.4 The B Vitamins 536
26.4.1 Folate 536
26.4.2 Vitamin B12 537
26.5 Brain Lesions 538
26.6 Recommendations 538
References 538
Part IV: New Frontiers in Preventive Nutrition 543
Providing Food and Nutrition Choices for Home and Community Long Term Living 544
27.1 Introduction 544
27.2 Nutrition and Chronic Disease Management 545
27.3 Nutritional Status, Malnutrition and Functionality 545
27.4 Caregivers and Nutritional Status 546
27.5 The Changing Long Term Care System 546
27.6 Opportunities And Challenges Within The Home- And Community-Based Long Term Care System 549
27.7 The Older Americans Act And Rebalanced Long Term Care 550
27.8 The Oaa Nutrition Program As A Service Model For Food And Nutrition Choices 551
27.9 OAA Nutrition Program And Frail Older Adults 554
27.10 Providing Food And Nutrition Choices For Home And Community Long Term Living: Recommendations 554
References 556
Dietary Supplements: Current Knowledge and Future Frontiers 558
28.1 Introduction 559
28.1.2 Overview of Dietary Supplement Use 559
28.1.2 Regulation of Dietary Supplements 560
28.1.2 Health Claims for Foods and Supplements 561
28.1.2 Evaluating the Quality of the Literature on Studies Using Dietary Supplements 562
28.2 Recommended Dietary Intakes for the Elderly 563
28.2.1 B Vitamins and Cognitive Function 565
28.2.2 B Vitamins and Cardiovascular Health 574
28.2.3 Vitamin E and Cancer Prevention 576
28.2.4 Vitamin E and Cardiovascular Health 577
28.2.5 Potassium and Cardiovascular Health 578
28.2.6 Selenium and Cancer Prevention 579
28.2.7 Calcium, Vitamin D, Osteoporosis, and Fractures 580
28.2.7.1 Calcium 580
28.2.7.2 Vitamin D 581
28.2.8 Magnesium and Reduction of Cardiovascular Risk 582
28.2.9 Omega-3 Fatty Acid and Cardiovascular Health 584
28.2.10 Omega-3 Fatty Acids and Cancer Prevention 585
28.2.11 Multivitamin/Mineral Supplements for Health Maintenance 585
28.3 Dietary Supplements with Accumulating Evidence for Risk Reduction for Chronic Disease 586
28.3.1 Black Cohosh (Cimicifuga racemosa) 615
28.3.2 Coenzyme Q10 (Ubiquinone) and Cardiovascular Health 615
28.3.3 Coenzyme Q10 (Ubiquinone) and Cognitive and Neurological Health 617
28.3.4 Ginkgo Biloba and Cognitive Function 617
28.3.5 French Pine Bark (Pinus pinaster Extract) and Chronic Venous Insufficiency 618
28.3.6 Saw Palmetto (Serenoa repens) and Prostate Health 619
28.3.7 Combination Supplements with Demonstrated Efficacy 619
28.4 Guidelines for Safe use of Dietary Supplements 620
28.4.1 Safeguarding Against Potential Interactions with Dietary Supplements 621
28.4.2 Clinical Needs Assessment for Dietary Supplements 622
28.1 Appendix: Reference Sources for Information on Dietary Supplements and Herb-Drug Interactions 624
28.1.2 Monographs 624
28.1.2 Books and Publications 624
28.1.2 Databases 624
References 625
Minimizing the Impact of Complex Emergencies on Nutrition and Geriatric Health: Planning for Prevention is Key 639
29.1 Introduction and Definitions 639
29.1.1 Definitions 640
29.1.2 Food Insecurity and Federal Food Assistance Programs 642
29.2 Complex Emergencies that Threaten Health 643
29.2.1 Natural Disasters and Extreme Weather 644
29.2.1.1 Hurricanes, Tornadoes, and Floods 644
29.2.1.2 Earthquakes 645
29.2.1.3 Extreme Heat and Cold 646
29.2.2 Unintentional and Intentional Man-Made Disasters 647
29.2.2.1 Fires 647
29.2.2.2 Epidemics, Pandemics, and Unintentional Food Borne Illness Outbreaks 647
29.2.2.3 Terrorism and Bio-terrorism 648
29.2.2.4 Summary 649
29.3 Minimizing Nutritional and Health Risks Due to CES 649
29.3.1 Conceptual and Programmatic Overview 649
29.3.2 Emergency Preparedness in Structured Living Communities 650
29.3.3 Emergency Preparedness at Home 651
29.3.3.1 Helping Older Adults to be Prepared: A Quality Improvement Study of Emergency Kits for Elders 651
29.3.4 Intervention Strategies: Providing Aid During and Following a CE 653
29.3.4.1 Coping with Food and Water Shortages 654
29.3.4.2 Re-Establishment of Basic Services and Access to Medical Care 655
29.4 Recommendations 656
References 656
Index 659
About the Editors 673