The week 4 signature Diet Analysis assignment has been designed for you to analyze and assess your own diet using the US Dietary Guidelines for Americans.
Please utilize the attachment to help you complete this assignment. it is very detailed.
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Public Health Nutrition
DIET ANALYSIS ASSIGNMENT
Points Possible: 140
The week 4 signature Diet Analysis assignment has been designed for you to analyze and assess your own diet using the US Dietary Guidelines for Americans.
Objectives:
· The student will be able to analyze their current dietary habits using an on-line program of their choice or MyPlatePlan PDF document (Dietary Guidelines for American’s).
· The student will be able to evaluate their 3-day dietary intake against the Dietary Guidelines for American’s as well as a set of recognized dietary standards as presented throughout their textbook and class notes. In addition, students will have the opportunity to discuss components of the assignment in a non-graded asynchronous discussion thread week 1, 2, 3, and 4.
· The student will be able to complete a written report using listed criteria, which includes a personal plan for dietary changes.
· The student will be able to design a diet plan based on the Dietary Guidelines for American’s.
General Instructions:
This assignment has three phases:
· Data Collection – 3 Days (2-weekdays, 1-weekend day) Dietary data collection on provided food intake forms
· Data Input – Accurate data input into online Diet Analysis program
· Discussion and Analysis – Discussion and analysis of Diet Analysis data
This assignment has two sections assembled exactly as detailed in the Table of Contents example:
· Section 1 – Analysis and Essay
· Written in APA formatting (Times New Roman or Arial font 12, 1” Margins; Double Spaced)
· At least Length 8-10 numbered pages (Writing and Analysis)
· Section 2 – Diet Analysis Data Collection
· Screen shots of completed diet analysis.
Data Collection – Choose three days, one of which is either a Saturday or Sunday. Include each food, how it was prepared, and the exact amount you consumed. Keep track of your emotional status during meal or snack time. It is optional to keep track of your exercise activities, the duration of exercise in minutes, and the intensity of exercise. It is important that the data collections be recorded as accurately as possible, pay specific attention to portion sizes and descriptions of food items.
Data Input – Input data (i.e. your foods and beverage) into the computer program of your choice. (see PowerPoint notes posted in weeks 1 and 4). Based on your daily activities, choose an appropriate activity level when requested on the computer program. Type food items consumed for each of the three days separately, as a result you will be able to printout a nutrient summary for each day as well as a three-day average.
Please note some additional recommendations. First, include in your “diet” analysis ONLY foods, NO supplements, bars, pills, or powders. You make select to complete a fourth day to compare, if you would like to compare your food intake vs your supplement intake. Second, use bottled water ONLY when recording water intake (even if you drink tap water). Finally, do NOT create a recipe of your own. If you can’t find the exact food item, select a food that is similar in-terms of macro and micro nutrient content.
Discussion and Analysis – Using the information obtained from the Diet Analysis printouts, class notes, and information printed in the text, you will analyze and evaluate your diet in comparison to the Dietary Guidelines for American’s and other recognized dietary standards. Additionally, you will develop a personal plan to improve dietary habits. Finally, a reflection from a public/community health educator’s perspective.
This assignment must be presented in an APA essay format following the provided Table of Contents template EXACTLY. The Discussion and Analysis sections must include an introduction, organized body, and a conclusion. Papers should be proof read free of grammatical errors and misspelled words.
NOTES:
· APA formatting of the paper to include both in-text citations AND references are required.
TABLE OF CONTENTS
SECTION 1 – Discussion and Analysis
I. Introduction of the paper
…………………..
[ ]
II. Weekday VS Weekend Dietary Comparison
…………………..
[ ]
III. Carbohydrate Intake Analysis
…………………..
[ ]
a. Carbohydrate Table
…………………..
[ ]
IV. Fiber Intake Analysis
…………………..
[ ]
V. Caloric Intake VS Caloric Needs Analysis
…………………..
[ ]
a. Calorie Graph
………………..…..
[ ]
VI. Body Mass Index Analysis
…………………..
[ ]
VII. Energy Balance Analysis
…………………..
[ ]
VIII. Fat Analysis
…………………..
[ ]
IX. Protein Analysis
…………………..
[ ]
X. Vitamin & Mineral Intake and Analysis
…………………..
[ ]
a. Vitamin & Mineral Table
…………………..
[ ]
XI. Vitamin & Mineral Supplement Analysis
…………………..
[ ]
XII. Diet and Exercise Lifestyle – Changes & Goals
…………………..
[ ]
XIII. Reflection: This section is the focus for this class * Write at least 1 full pages on this section!
SECTION 2 – Presentation of Data
XIV. Forms and Printouts
a. Complete 3-Day Diet Analysis/Screen Shots
i. Profile
(see sample)
…………………..
[ ]
ii. Nutrient Report (see sample)
…………………..
[ ]
iii. Daily Activity Log (optional)
…………………..
[ ]
XV. Reference page in APA format
…………………..
[ ]
Your assignment must be in the following order with all questions answered in the order they are asked. Remember this is an ESSAY!!!
No
t, questions and answers. Essays include a clear introduction, organized body, and a conclusion.
SECTION 1 – Discussion and Analysis
I. Introduction of the paper
a. Introduction – Introduce the paper and give an overall synopsis of the project.
II. Weekday VS Weekend Dietary Comparison (10 Points)
b. Using quantifiable measures (i.e. 14 grams, milligrams, 22%, or cups) and the Dietary Guidelines for American’s (i.e. https://www.supertracker.usda.gov/) compare and contrast your food intake from the weekend to the weekday.
i. For example:
1. Does your food/beverage intake differ from weekday to weekend?
2. Do the days differ in breakdown of carbohydrates, protein, and fat from the recommended diet according to the Dietary Goals found in your Diet Analysis?
3. Do you see a trend in how emotions play a role in your eating behavior?
4. Did alcohol contribute to your daily caloric intake?
III. Carbohydrate (CHO) Intake Analysis (10 Points)
c. Insert a table listing ALL the carbohydrates you consumed on your food intake sheets over your three-day sample period. Classify carbohydrates as “Simple CHO” or “Complex CHO” then rate the carbohydrates as a source of fiber. Show your calculation for ALL foods containing FIBER.
CARBOHYDRATE TABLE EXAMPLE
CHO Foods |
Simple CHO |
Complex CHO |
Define Source of Fiber |
||
Apple with Skin |
Yes |
||||
Regular Soda |
No | ||||
Raisin Nut Bran Cereal |
“excellent source” 5/25 x 100 = 20% |
Note: Simple carbohydrates (CHO) are foods made up of the monosaccharides (glucose, fructose, and galactose) and/or disaccharides (maltose, sucrose, and lactose).
Note: Definition for “good source of”: the product provides between 10 and 19% of the Daily Value for a given nutrient per serving.
Note: Definition for “high, rich in, or excellent source”: 20% or more of the Daily Value for a given nutrient per serving.
Note: Show calculations. Example you consumed one serving of Raisin Nut Bran Cereal which provides 5 grams of fiber (see the label), the Recommended Fiber intake according to Daily Values (DV) is 25 grams per day. 5 divided by 25 x 100 = 20% (this is an “excellent” source of dietary fiber).
d. How can increasing your intake of complex carbohydrates / fiber along with reducing your intake of concentrated sweets improve your health status?
IV. Fiber Intake Analysis (5 Points)
a. Define the recommended dietary fiber intake.
b. If your dietary fiber intake was below recommended amounts what type of foods and in what amounts could you realistically add to your diet to increase fiber intake?
c. If dietary fiber intake was adequate, list the foods that contributed significant amounts of fiber to your diet.
V. Caloric Intake VS Caloric Needs Analysis (5 Points)
a. Using a bar graph, compare your actual three-day average caloric intake versus the recommended caloric intake found in your Diet Analysis.
1550160016501700175018001850RecActual
Calories
b. Describe your daily activities and justify the activity factor you chose for the Diet Analysis data entry.
c. Would you expect to lose, gain, or maintain weight if you consistently consumed this calorie level?
VI. Body Mass Index (BMI) Analysis (5 Points)
a. Compare your BMI results to standards found in the class textbook. (BMI is NOT percent body fat.)
b. State your results, and evaluate them against the appropriate standard.
c. Would you want to maintain, or change the BMI results? Why?
d. Is the BMI method the most useful in assessing health risk?
e. Is there another method that would give you more useful information?
VII. Energy/Calorie Balance Analysis (5 Points)
a. Considering your answers in (IV) Caloric Intake VS Caloric Need and (V) BMI Analysis, what changes do you need to make with regard to energy balance?
b. Do you need to increase or decrease calories and/or change the amount of your physical activity?
c. What results would you want to achieve with these changes?
VIII. Fat Analysis (10 Points)
a. Discuss your total percentage of calories from fat (recommended: 30% or less).
b. Evaluate the percentage of saturated fat calories in your diet (recommended: 10% or less).
c. Evaluate your cholesterol intake using the American Heart Association standard (max 300 mg).
d. Are there any areas of concern in your dietary saturated fat, total fat, or cholesterol?
e. How would your eating habits be altered to control problem areas? Use several specific examples from your food choices to illustrate.
IX. Protein Analysis (5 Points)
a. Discuss your main sources of protein.
b. Compare these sources of protein with sources of saturated fat.
c. How would eating plant protein vs. animal protein impact your saturated fat and total fat intakes?
d. What are your concerns surrounding high protein diets?
e. Define complete vs. incomplete proteins, and discuss them in the context of your dietary habits.
X. Vitamin & Mineral Intake and Analysis (20 Points)
a. Using a table format (See Example), Compare your actual vitamin and mineral intake to the recommendations listed on your Diet Analysis profile.
Vitamin & Mineral Intake and Analysis Table (Example)
Vitamin Mineral |
Rec Intake |
Actual Intake |
% of Intake |
Deficiency |
Toxicity |
* WNL |
||
Vitamin D |
5 mcg |
4 mcg |
80 % |
N |
Y |
The most toxic of all vitamins. UL 50 mcg etc… |
Children: Rickets Adults: Osteomalacia etc….. |
|
Calcium |
||||||||
Iron |
||||||||
Potassium |
||||||||
Sodium |
* WNL = Within Normal Limits
b. Compare the following nutrients
i. Vitamin D
ii. Calcium
iii. Iron
iv. Potassium
v. Sodium
c. In general, consuming less than 75% of your daily needs of vitamins and minerals, puts you at risk for deficiency. Consuming more than 200% of your daily needs, puts you at risk for toxicity.
d. Possible deficiencies and toxicities should be included in your table as well as your written summary.
e. Are toxicities a concern?
f. Are deficiencies a concern?
g. How would you correct any possible deficiencies or toxicities?
h. List foods you would actually eat to correct deficiencies or toxicities.
XI. Vitamin & Mineral Supplement Analysis (5 Points)
a. Are you taking any vitamin or mineral supplements?
b. If so, discuss supplement amounts compared with the amounts obtained in food.
c. If not, are supplements necessary based on your findings?
d. Are there any supplements you should be taking?
XII. Diet and Exercise Lifestyle – Changes & Goals (20 Points)
a. Considering problem areas identified in your diet and exercise lifestyle, list three specific changes you are willing to make to improve your personal nutrition habits.
b. Set one goal each for achieving each of these three changes.
i. In stating your goals, use specific examples of either food choices or physical activity.
1. One of these changes is to be implemented immediately (such as switching to 1% milk).
2. Another change is to be implemented in the next six months (such as reducing sugar intake to no more than 50 grams of added sugar per day).
3. The third change is to be implemented in the next year (such as exercising daily).
c. How successful do you think you will be in achieving these goals?
***Keep in mind to point value for this question!
XIII. Reflection (20 Points) * This section is the focus for this class * Write at least 1 full page on this section!
a. Now that you have an in-depth understanding of the USDA Dietary Guidelines (i.e. MyPlate); Do you believe that most Public Health/Community Health educators and professionals understand how to use the USDA MyPlate website? Why or Why not?
b. Give detailed example to support your position.
SECTION 2 – Presentation of Data
I. Forms and Printouts (15 Points)
a. Complete 3-Day Diet Analysis/Screen Shots
i. Profile
(see sample below)
ii. Nutrient Report (see sample below)
iii. Daily Activity Log (optional)
II. Reference page in APA format ( 5 points)
b. Correct use of in-text and reference list in APA format
Additional Sources regarding APA
1.
2.
http://owl.english.purdue.edu/owl/resource/560/01/
3.
http://apa.org/
Additional Sources from the course textbook
c. Appendix A
d. Appendix B
e. Appendix D
f. Appendix H
Screen shoots examples below ( yours will be unique and different)
_1364907273.xls
Chart1
1650
1850
Calories
Sheet1
Rec Actual
Calories 1650 1850
The signature assignment in this course will be a personal 3-day diet analysis. Each student will journal, then analyze their own food intake either using a program of their choice or using the MyPlatePlan to find the calorie level that is right for you based on your age,sex, height, weight, and physical activity level. Print or download a corresponding MyPlate Plan PDF to use in tracking your food choices. A program, I recommend for students is
My Plate Calorie Counter
as it is more complete and it has worked for many students previously. I am very flexible regarding the app use for this assignment. Familiarity with the Dietary Guidelines for Americas should be considered a fundamental experience for all aspiring public health professionals as most community health intervention programs use the guidelines as a foundation of their messaging and community educations.
Week one
Assignments:
1. Take a close look at the Week 4 Signature Diet Analysis Assignment.
2. Go to the program of your choice website and create a profile for your diet analysis.
Please click on the links below to download and view the lectures for this week.
Week One Overview
– PowerPoint File (97 KB)
·
Chapter One PowerPoint
– PowerPoint File (433.1 KB)
·
Chapter Two PowerPoint
– PowerPoint File (640.2 KB)
·
Chapter Ten PowerPoint
– PowerPoint File (1.07 MB)
Week two
Assignments:
1. Take a close look at the Week 4 Signature Diet Analysis Assignment.
2. If you haven’t, go to the website program dietary tracker or your choice or
MyPlate Calorie Counter
3. Write down everything you eat and drink for 3 typical non-consecutive days (2 weekdays AND 1 weekend).
4. Data enter all foods for the 3 days you have selected as “typical” eating days for yourself.
5. View the Nutrient Report
6. In preparation for the completed assignment due Week 4 Day 6, you should answer sections I through VI of your signature assignment.
7. Attend the optional Blackboard Collaboration (BBC) seminar.
Week Two Overview
–
·
Chapter 9 PowerPoint
– PowerPoint File (542.5 KB)
·
Chapter 11 PowerPoint
– PowerPoint File (621.4 KB)
Week three
Assignments:
1. Take a close look at the Week 4 Signature Diet Analysis Assignment.
2. If you haven’t, go to a web program of your own or
MyPlate Calorie Counter
and create a profile.
3. Using the Nutrient Report, make any correction or adjustments as needed.
4. In preparation for the completed assignment due Week 4 Day 6, you should answer sections VII through X of your signature assignment.
Week Three Overview
– PowerPoint File (412.4 KB)
·
Chapter 4 PowerPoint
– PowerPoint File (2.7 MB)
·
Chapter 18 PowerPoint
– PowerPoint File (530.9 KB)
Week 1
This week as we dive into community & public health you will learn about the relationship between eating behaviors and chronic disease.
You will become acquainted with Healthy People 2020 (written health goals & objectives for the nation) and learn how to analyze dietary data.
Lastly, you will begin to conduct a nutrient analysis on your food intake and by week four write a signature paper on your findings.
Week 2 Overview
This week you will explore the nutrition related concerns during childhood and adolescence.
Review and discuss the effects of TV on children’s health outcomes
Explore the health concerns of the elderly.
Week 3 Overview
This week you will explore various levels of food insecurity in the U.S.
Review public health programs designed to meet the needs of the poor.
Define cultural competence
Review and discuss health disparities
Chapter 1
Community Nutrition
and Public Health
Community Nutrition and Public Health
Community nutrition is a modern and comprehensive profession that includes, among other disciplines, public health nutrition.
Community nutrition is the part of nutrition that deals with a variety of food and nutrition issues related to individuals, families, and special groups with a common link such as place of residence, language, culture, or health issues.
The Concept of Community
The World Health Organization (WHO) defined community as a social group determined by geographic boundaries and/or common values and interests.
Community members know and interact with one another, and function within a particular social structure and show and create norms, values, and social institutions.
Suburbs and other areas surrounding the legal limits of a city are also an integral part of the total community.
The Concept of Community Continued
A community is also the demographic such as age, gender, social class, or race.
A community can be defined on the basis of a common interest or goal.
A collection of people, even if they are scattered geographically, can have a common interest. This is called a common-interest community.
The Concept of Community Continued
Examples of common-interest communities:
Members of a national professional organization (i.e., The American Dietetic Association)
Members of churches
Disabled individuals scattered throughout a large city
Individuals with specific health conditions (e.g., diabetes, hypertension, breast cancer, mental illness)
Teenage mothers
Homebound elderly persons
Public Health and Nutrition
Public health is the science and art of preventing disease, prolonging life, and promoting health through organized community effort.
Community nutrition and dietetics professionals are members of community and public health agencies who are responsible for nutrition services that emphasize community health promotion and disease prevention.
They deal with the needs of individuals in primary, secondary, and tertiary prevention.
Public Health and Nutrition Continued
Public health has been viewed as the scientific diagnosis and treatment of the community.
In this vision, the community, instead of the individual, is seen as the patient.
The focus is on the community’s strengths and resilience.
Public Health and Nutrition Continued
Community strengths can be physiological, psychological, social, or spiritual.
They include such factors as:
Education, coping skills, support systems, knowledge, communication skills, nutrition, coherent belief systems, fitness, ability to develop a supportive environment, and self-care skills.
Public Health and Nutrition Continued
Public health nutrition was developed in the United States in response to the prevention of diseases, societal events, and changes of the following situations:
Infant mortality
Access to healthcare
Epidemics of communicable disease
Poor hygiene and sanitation
Malnutrition
Agriculture and food production
Economic depression, wars, and civil rights
Public Health and Nutrition Continued
Aging of the population
Behavior-related problems/lifestyle (poor dietary practices, alcohol abuse, inactivity and cigarette smoking)
Chronic diseases (obesity, heart disease, diabetes mellitus, mental health, cancer osteoporosis, and hypertension)
Poverty and immigration
Preschool/after-school childcare and school-based meals
The Relationship Between Eating Behaviors and Chronic Diseases
The relationship between the eating behavior and chronic disease is significant and impacts individuals and communities greatly.
Different health agencies have provided comprehensive analyses of the relationship between diet, lifestyle, and major chronic diseases.
Table 1-1 shows dietary factors that are linked to some of the most common chronic diseases.
The Major Causes of Chronic Diseases, Death, and Disability in the United States
Nephritis, nephritic syndrome, and nephrosis
Septicemia
Suicide
Chronic liver disease and cirrhosis
Hypertension
Parkinson’s disease
Assault (homicide)
Heart disease
Cancer
Stroke
Chronic lower respiratory disease
Accidents
Diabetes
Pneumonia/influenza
Alzheimer’s disease
The Ten Leading Causes of Death
in the World
Ischaemic heart disease
Stroke
Acute lower respiratory infections
HIV/AIDS
Chronic obstructive
Pulmonary disease
Perinatal conditions
Diarrheal diseases
Tuberculosis
Malaria
Reducing Risk Through Prevention
The three important parts of prevention are personal, community-based, and systems-based health.
Personal health prevention is at the individual level, for instance, educating and supporting a breastfeeding mother for promoting the health of her infant.
Reducing Risk Through Prevention Continued
Community-based prevention targets groups such as public campaigns for low-fat diets to decrease the incidences of obesity and/or heart disease.
Systems-based prevention deals with changing policies and laws in order to achieve the objectives of prevention practice.
For example, laws regarding childhood immunization, food labels, food safety, and sanitation.
Reducing Risk Through Prevention Continued
Another example of system-based prevention is the socioeconomic status that affects health through environmental or behavioral factors.
Socioeconomic model hypothesizes that poor families do not have the economic, social, or community resources needed to be in good health.
The link between socioeconomic status and health related problems is triggered and maintained by two processes.
Selection
Causative
Levels of Prevention
Primary prevention is an early intervention focused on controlling risk factors or preventing diseases.
Secondary prevention includes identifying disease early (before clinical signs and symptoms manifest) through screening.
Tertiary prevention is intervention to reduce the severity of diagnosed health conditions in order to prevent or delay disability and death.
Health Promotion
A process of enabling people to increase control over, and to improve, their health.
The strategies that can be used to design a health promotion campaign in order to reduce risk are:
The population approach
The individual approach
Knowledge and Skills of Public and Community Nutritionists
An interdisciplinary team is collaboration among personnel representing different disciplines of public health workers.
Community and public health nutritionists use various approaches to diagnose and address the public or community issues:
Utilize interventions that promote health and prevent communicable or chronic diseases by managing or controlling the community’s environment.
Knowledge and Skills of Public and Community Nutritionists Continued
Channel funds and energy to problems that affect the lives of the largest numbers of people in a community.
Seek out the unserved or underserved populations (due to income, age, ethnicity, heredity, or lifestyle) and those who are vulnerable to disease, hunger, or malnutrition.
Knowledge and Skills of Public and Community Nutritionists Continued
Monitor the public or community’s health in relation to public health objectives and continuously address current and future needs.
Plan, organize, manage, direct, coordinate, and evaluate the nutrition component of health agency services.
Collaborate with the public, consumers, community leaders, legislators, policy makers, administrators, and health and human service professionals in assessing and responding to community needs and consumer demands.
Knowledge and Skills of Public and Community Nutritionists Continued
In order for community nutritionists to accomplish the actions listed, they need to acquire normal and clinical nutrition knowledge and be skilled in educating the public.
Minimum education requirements for a community nutritionist include:
Bachelor’s degree in foods and nutrition or dietetics from an accredited college or university
Master’s degree in public health with a major in nutrition
Master of Science degree in applied human nutrition with a minor in public health or community health
Knowledge and Skills of Public and Community Nutritionists Continued
Marketing skills are very important because they help nutritionists know how to convey effective nutrition messages using a variety of media format for their audiences.
In some situations, Dietetic Technicians, Registered (DTRs) are employed in the food service area, clinical settings, and in community situations.
DTRs are required to graduate with at least an associate’s degree from an approved educational program.
Place of Employment for Public Health and Community Nutritionists
Community and public health nutritionists work in official community settings or voluntary agencies to promote health, prevent disease, conduct epidemiological research, and provide both primary and secondary preventive care.
Place of Employment for Public Health and Community Nutritionists Continued
Example places of employment:
State/City/County Levels
Cooperative extension services
Home healthcare agencies
Hospital outpatient nutrition education departments
Native American health services
Local public health agencies
Migrant worker health centers
Neighborhood or community health centers
Place of Employment for Public Health and Community Nutritionists Continued
Non-profit and for-profit private health agencies
Universities, colleges, and medical schools
Wellness programs
National/Federal/Regional Levels
Food and Drug Administration (FDA)
U.S. Department of Agriculture (USDA)
U.S. Department of Health and Human Services (USDHHS)
Place of Employment for Public Health and Community Nutritionists Continued
International Level
Food and Agriculture Organization of the United Nations (FAO)
Pan American Health Organization (PAHO)
World Health Organization (WHO)
World Food Agency (WFA)
United Nations Children’s Emergency Fund (UNICEF)
United Nations Organization (UNO)
Preventive Nutrition
Preventive nutrition is dietary practices and interventions directed toward the reduction in disease risk and/or improvement in health outcomes.
Cooperative Extension System
The Cooperative Extension (CE) System is an agency under the U.S. Department of Agriculture.
It provides educational programs that help individuals and families acquire life skills.
Currently, extension works in six major areas:
4-H Youth Development—helps the youths make life and career choices.
At-risk youth participate in school retention and enrichment programs.
They learn science, math, social skills using hands-on projects and activities.
Cooperative Extension System Continued
Agriculture—helps individuals learn new ways to improve their income through research-based management skills, resource management, controlling crop pests.
Leadership Development—trains extension professionals and volunteers to serve in leadership roles in the community.
Cooperative Extension System Continued
Natural Resources—provides educational programs in water quality, timber management, composting, lawn and waste management, and recycling to landowners and homeowners.
Family and Consumer Sciences—teaches families and individuals nutrition, food preparation skills, positive childcare, family communication, financial management.
Cooperative Extension System Continued
Community and Economic Development—helps local governments improve job creation and retention, small and medium-sized business development.
The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded program designed specifically for nutrition education.
The county extension home economists provide on-the-job training and supervise paraprofessionals and volunteers who teach low-income families and individuals.
Cooperative Extension Nutrition Program Successful Strategy
Programs that have demonstrated effective community interventions for a decrease in dietary fat include a program from South Carolina, which incorporated:
community nutrition classes, grocery store tours, speakers’ bureaus, professional education classes, home study courses, and worksite nutrition education programs
The National Cancer Institute Health Promotion Intervention’s Successful Strategy
The Working Well intervention was based on a conceptual model that incorporated three important elements:
The use of participatory strategies operated through a primary worksite contact and an employee advisory board.
An ecological approach targeting both individual behavior change and change in environmental and organizational structures.
The National Cancer Institute Health Promotion Intervention’s Successful Strategy Continued
The use of adult education and behavior change strategies in all aspects of intervention planning and delivery.
Discussion Topics
What is the difference between primary, secondary and tertiary prevention?
What is the interrelationship between nutrition and physical activity in promoting health and preventing obesity?
What is the relationship between diet and diseases?
What are the leading causes of death in the United States and the world?
Chapter 2
Nutrition Screening and Assessment
Nutrition Screening and Assessment
Community assessment is the process of critically thinking about the community that involves getting to know and understand the community as a client.
Community assessment helps identify community needs, clarify problems, and identify strengths and resources.
Nutrition Screening and Assessment Continued
Community nutrition assessment is an attempt to evaluate the nutritional status of individuals or populations through measurements of food and nutrient intake and evaluation of nutrition-related health indicators.
Nutrition Screening and Assessment Continued
The U.S. Department of Health and Human Services defines nutritional assessment as “the measurement of indicators of dietary status and nutrition-related health status to identify the possible occurrence, nature, and extent of impaired nutritional status,” which can range from deficiency to toxicity.
The Purpose of Community Nutrition Assessment
The purpose of a broad community nutrition assessment is to reveal the important nutrition-related needs in the community and finding opportunities for intervention.
A nutritional assessment of the community uses nutritional status measures acquired from anthropometric, biochemical, clinical, and dietary intake data as well as epidemiological information.
The Purpose of Community Nutrition Assessment Continued
Community nutrition assessment also needs to include the following:
The health of individuals within the community
The health of the community itself
Identifying the characteristics, resources, and needs of the community
Working with community members on those issues that arise
Addressing not only individuals’ behaviors, but also applicable environmental variables
Historical Development of Nutritional Assessment
In 1932, the Health Organization of the League of Nations (HOLN) held the first conference to discuss the physical, clinical, and physiological aspects of nutrition assessment in Berlin.
This conference motivated the publication of the procedures for conducting nutrition surveys.
In the United States, before the 1960s, the incidence of malnutrition was not noticed because little or no attention was given to nutritional health.
Historical Development of Nutritional Assessment Continued
Between 1968 and 1970 the National Center for Health Statistics (NCHS) conducted:
The Ten-State Nutrition Survey (TSNS)
The First National Health and Nutrition Examination Survey (NHANES) in 1971–1974
These surveys discovered evidence of clinical and subclinical malnutrition in individuals in different areas of the country.
Historical Development of Nutritional Assessment Continued
Results showed that population groups that were at nutritional risk were also socially, economically, educationally, or medically deprived.
Malnutrition was associated with poor growth, developmental disability, poor pregnancy outcomes, susceptibility to infectious diseases, delayed recovery from illness, and reduced life expectancy.
Historical Development of Nutritional Assessment Continued
1976–1980: NHANES II was conducted and it targeted non-institutionalized persons from 6 months to 74 years old.
It used a similar data collection method as the NHANES I.
1982–1984: The Hispanic Health and Nutrition Examination Survey (HHANES) was conducted.
1988–1994: The third NHANES survey was conducted used nationwide samples of about 40,000 non-institutionalized persons, ages 2 months and older.
Growth Charts
In 1977, the National Center for Health Statistics (NCHS) developed growth charts as a clinical tool for health professionals to determine if the growth of a child was adequate.
In 1977, the World Health Organization (WHO) also adopted the growth charts to be used internationally.
The 1977 growth charts were revised and updated to make them a more valuable clinical tool for health professionals.
The 2000 Centers for Disease Control and Prevention (CDC) growth charts represent the revised version of the 1977 NCHS growth charts.
Growth Charts Continued
The new BMI growth charts can be used clinically beginning at 2 years of age when an accurate stature can be obtained.
To establish the BMI of a client(s), measure height without shoes and weight with minimal clothing. Then use these numbers in the equation to calculate the BMI.
Community Needs Assessment
A needs assessment measures the current situation of a particular group or community.
In addition, a community needs assessment survey can be conducted when community groups want to take action, influence policy, or make changes.
Community Needs Assessment Continued
Needs assessment studies allow community groups or sponsoring agencies to:
Collect information about community attitudes and opinions regarding specific nutrition, health, and other issues
Determine how the communities would prioritize the issues
Provide the community the opportunity to determine policy, goals, methods, and procedures for solving the problem
Evaluate current programs and policies and available resources
Methods of Performing a Community Needs Assessment
The five frequently used approaches for collecting information of community needs are:
Existing Data Approach
Survey Approach
Key Informant Approach
Community Forum
Focus Group Interview
Methods of Performing a Community Needs Assessment Continued
Existing Data Approach: The nutritionist can use existing statistical data such as national vital statistics to obtain information about the well-being of people.
This approach uses descriptive statistics such as census data, labor surveys, income data, NHANES data for food consumption pattern, USDA data of Food Stamp Program, and school.
Methods of Performing a Community Needs Assessment Continued
Advantage
The data is available and is less expensive to use.
Disadvantage
The nutritionist must relate the data to nutrition issues for that particular community.
Methods of Performing a Community Needs Assessment Continued
Survey Approach: This approach requires some training or experience on how to create and administer survey questionnaires (e.g., writing clear and precise questions).
The nutritionist should consider the following before deciding to use this approach:
Cost of implementation
Time needed for completion
Rate of refusal of individuals to participate
Magnitude and type of training the supporting staff need
Methods of Performing a Community Needs Assessment Continued
Advantages
Entire population may be surveyed.
It provides an opportunity for many people to feel involved in the decision-making process.
It can be used in combination with other assessment techniques.
Disadvantages
It may be expensive.
It requires a great deal of time and expertise to develop the survey, train interviewers or staff, conduct interviews, and analyze and interpret the results.
Methods of Performing a Community Needs Assessment Continued
Key Informant Approach: This approach requires the nutritionist to first identify the key leaders, decision makers, and professionals in the community who can identify priority needs and concerns of the community accurately.
Methods of Performing a Community Needs Assessment Continued
Advantages
This technique can be combined effectively with other techniques.
It is inexpensive, and allows continuous clarification of ideas and information.
Disadvantages
Additional approach is required because it does not represent the total community perspective.
The information obtained from this technique may represent a biased perspective.
Methods of Performing a Community Needs Assessment Continued
Community Forum: A public meeting(s) is held and the participants discuss the needs of the community.
Methods of Performing a Community Needs Assessment Continued
Advantages
It allows input from many individuals with different perspectives on community needs.
It provides opportunity for all the community members to participate.
In-depth information can be collected.
It can be combined with other techniques.
Disadvantages
The information collected may be limited to those who agreed to participate.
Only those who are more vocal will be heard if the forum is not well conducted.
It may generate more questions than answers.
Methods of Performing a Community Needs Assessment Continued
Focus Group Interview: This approach involves selecting and interviewing people for their particular skills, experiences, or positions.
Methods of Performing a Community Needs Assessment Continued
Advantages
It can be used to expand the data obtained from surveys or existing data.
The data can be used to create specific survey for future use.
It provides opportunity to clarify ideas, and stimulates critical thinking.
Disadvantages
It does not give everybody in the community the opportunity to provide ideas.
It requires combining with other technique since data from this approach may not be enough.
A Framework for Performing an Assessment
The WHO and other authors suggested the following nine-step framework that provides a useful guide for planning and conducting a needs assessment:
Decide when to conduct the needs assessment and set up a committee. Then develop a plan of action.
List important issues or needs of the community.
Decide what information needs to be collected after reviewing available information.
Determine the target population to be surveyed and how the data will be collected.
A Framework for Performing an Assessment Continued
Determine the availability of existing data, and what information need to be gathered using a survey. Determine the cost estimates and the time frame.
Identify and train the assessment team. Pretest the questionnaire, and then select a sample of the individuals to survey.
Collect the data.
Analyze the data.
Interpret the results to identify priority needs, possible intervention strategies, and resources.
Present the results of the needs assessment to all the stakeholders and the community members.
Nutritional Needs Assessment
Dietary assessment is the first step in identifying nutritional deficiency.
These methods are based on the dietary, laboratory, anthropometric, and clinical measures presented in Table 2-4.
It is typically required to consider other factors, such as socioeconomic status, cultural practices, and health and vital statistics in order to make a correct interpretation of the results of nutritional assessments.
Together, these factors are sometimes called “ecological factors.”
Nutritional Needs Assessment Continued
The main methods of assessing the food consumption of individuals include the following:
24-hour recall
Food diary
Food record
Dietary history
Food frequency questionnaire
Different Methods and Tools for Assessing Nutrition Status
Anthropometric Measurements and Body Composition are physical measurements of the body, such as height and weight, head circumference, girth measurement, or skinfold measurement.
National Center for Health Statistics Percentiles for Physical Growth (NCHSPG) charts are standard for evaluating the physical growth of males and females from birth to age 20 years.
Different Methods and Tools for Assessing Nutrition Status Continued
Biochemical Tests/Data measure body fluids such as blood, urine, or feces.
It is used mainly to detect subclinical deficiencies such as iron deficiency anemia.
Clinical Observations/Physical Examinations are methods used to determine physical signs of nutrient deficiency or excess that developed over a long period of time (advanced stage of nutrient deficiency).
Different Methods and Tools for Assessing Nutrition Status Continued
A clinical nutrition examination would observe the hair, nails, skin, eyes, lips, mouth, muscles, and joints.
Specific findings, such as changes in hair color, would suggest a protein deficiency.
Table 2-6 presents examples of generally used physical examination tests using appearance as an indicator of nutrition status.
Different Methods and Tools for Assessing Nutrition Status Continued
Dietary Assessment Methods dietary information may confirm a lack or excess of a dietary constituent detected by anthropometric, biochemical, or clinical evaluations.
Diet History is any dietary assessment that asks clients to report about their past diet.
It refers to the collection of the detailed (preparation methods and foods eaten in combination) make-up of meals.
The intake frequency of various foods plus other risk factors such as the economic status of the client.
Different Methods and Tools for Assessing Nutrition Status Continued
The Food Frequency Questionnaire (FFQ) asks how often the respondent consumed specific foods or groups of foods for a specific period.
Food Records or Diaries—the respondent provides detailed information about daily eating habits.
The respondent is usually asked to record all foods and beverages consumed during a defined period, typically over three to seven consecutive days.
Different Methods and Tools for Assessing Nutrition Status Continued
Twenty-Four-Hour Recall: This dietary assessment is termed a 24-hour recall because it is typically administered for a 24-hour period.
The respondents are asked to remember all foods and beverages they consumed in the past 24-hour period (usually midnight to midnight).
How to Analyze Dietary Intake Data
Comparison to Dietary Standards: The respondents’ nutrient intake can be compared to dietary standards using the Recommended Dietary Allowances (RDA) or Adequate Intake (AI) values.
Comparison to MyPyramid: The respondents’ food intake can be compared to MyPyramid, which is another type of dietary standard.
Comparison to Dietary Guidelines for Americans: The nutritionist can also compare the respondents’ diet to the Dietary Guidelines for Americans.
Screening for Community Health
Screening is an attempt to detect unrecognized or subclinical health conditions among individuals.
The purpose is to identify individuals who have a high risk of having or developing a specific health condition so they can be referred for definitive diagnosis and treatment.
Reliability and Validity of Screening
for Community Health
Reliability is the consistency or repeatability and reproducibility of test results or if a testing instrument will measure nutrient intake the same way twice on the same client.
Validity is the ability of the test instrument to measure what it is supposed to measure accurately.
The Purpose of Assessment
Assessment of dietary intake is very important to the work of improving the health of individuals, communities, and populations.
Berdanier et al. stated that dietary intake data are used for three major purposes:
Dietary assessment at the individual level can be used to determine the individual’s dietary adequacy and dietary patterns, and for educating and counseling the individual.
The Purpose of Assessment Continued
Dietary assessment is an essential component of research studies that determine the health of individuals and populations.
For example, etiologic studies assess dietary intake as an exposure for association with disease outcomes.
Behavioral research assesses dietary intake in order to develop and test strategies that encourage adoption of healthful eating patterns.
The Purpose of Assessment Continued
Dietary assessment also is important in identifying national health priorities, population subgroups at risk or in need of special assistance, and developing public health dietary recommendations at the population/ national level.
Reliability and Validity
Test results may yield invalid or unreliable results due to inconsistent administration of the instrument.
The validity and reliability of the test instruments also depend on the responses of the participants.
It is important to modify the instrument for a specific population.
Many other factors affect the reliability and validity of dietary assessment questionnaires, including:
Degree of variability permitted by the instrument (convenience of recording food intake, external environment, etc.)
Reliability and Validity Continued
Quality control of coding and keying
Real dietary change in the time between the two administrations of the questionnaire
Respondent characteristics (level of education, cultural background, age, etc.)
Questionnaire design
The qualifications of the interviewer
Adequacy of the reference data
Sensitivity and Specificity
A screening method with high sensitivity means there are few false negatives.
A sensitivity test is able to correctly identify and classify individuals within the population who are truly malnourished as confirmed by the test (a true positive).
A screening method with high specificity has few false positives.
A specificity test is able to correctly identify individuals who are not malnourished within a population (true negative).
Successful Community Strategies
The Delta NIRI conducted a comprehensive rural community assessment through five surveys:
Key informant survey
Food Of Our Delta survey (FOODS 2000)
Food store survey
Focus groups
Community resources assessment
Successful Community Strategies Continued
In one of the surveys (FOODS 2000), more than 1,500 people were followed by an in-store survey conducted in 174 stores, supermarkets, small to medium grocery stores, and convenience stores.
It identified the problems of access to and quality of foods in this high health risk, low-income region.
Topics for Discussion
What is the importance of nutrition screening and assessment?
What are the different methods a nutritionist can use to assess the community and why?
What is the importance of the national nutrition surveys, such as the NHANES surveys?
How can a nutritionist use different demographic and health statistics sources to assess the community needs?
Chapter 10
Adulthood: Special Health Issues
Adulthood: Special Health Issues
A chronic condition is an occurrence of a disease that is long term and extends over a period of time.
The risk factors of dietary practices are significant in several chronic diseases, including heart disease, stroke, cancer, obesity, and osteoporosis.
Healthy People 2010
The goal of Healthy People 2010 is to prevent and control chronic diseases such as heart disease, obesity, cancer, and osteoporosis.
Cardiovascular Disease
The cardiovascular system includes the heart, blood vessels, and the blood-forming organs.
Atherosclerosis
This hardening of the arteries occurs when fibrous plaques forms, which are composed mainly of cholesterol, build up in the arteries, especially at branch points.
The first sign of atherosclerosis is soft fatty streaks visible along the walls of the arteries.
Cardiovascular Disease Continued
This disease process interferes with the pumping of blood through the artery in two ways:
The deposits gradually narrow the opening.
The fibrosis makes it increasingly harder for the artery to constrict or dilate in response to the tissues’ need for oxygenated blood.
Coronary heart disease (CHD) is the most common form of cardiovascular disease.
It involves atherosclerosis and causes one-third of all deaths in both men and women.
Cardiovascular Disease Continued
Unmodifiable Risk Factors are risk factors that are not under the control of the individual such as age, gender, ethnicity, and family history.
Family History
A family history of premature CHD in a parent or sibling increases a person’s risk for the disease.
Premature CHD occurs in a male under the age of 50 or a female under age 60.
Cardiovascular Disease Continued
Modifiable Risk Factors: The major modifiable risk factors for CVD are hypertension, obesity, cigarette smoking, hypercholesterolemia, and diabetes.
Hypertension—there is a direct link between increase in blood pressure (BP) and CVD complications.
Cigarette smoking stresses the CVD system by depriving the heart of oxygen and raising the blood pressure.
Cardiovascular Disease Continued
Hypercholesterolemia is the total blood cholesterol level of over 200 mg/dl, especially at or over 240 mg/dl together with LDL cholesterol over 130 to 159 mg/dl, is associated with CVD.
The higher a person’s HDL levels, the lower the risk of coronary heart disease.
Obesity has increased over the past several decades, and has had a negative impact in reducing CVD morbidity and mortality.
Increase in the risk for CHD is observed in individuals with diabetes.
Cardiovascular Disease Continued
The National Cholesterol Education Program: The NCEP recommended several different strategies for identifying and managing individuals at risk for heart disease.
The strategies include either primary prevention for healthy individuals or secondary prevention for those at risk of heart disease.
Box 10-4 and Table 10-4 present the approaches for reducing the risk of heart disease and managing hypercholesterolemia.
Obesity
Obesity is due to the accumulation of excess body fat.
It increases the risk for:
high blood pressure
high blood cholesterol
type 2 diabetes
insulin resistance
coronary heart disease (CHD)
many other physical ailments
Obesity Continued
Defining Obesity and Overweight: Fat distributed around the hips and thighs (“pear shape”) or gynoid obesity is common in women.
Fat distributed around the abdomen (“apple” shape) or android obesity, found mainly in men, is linked to high blood lipids, glucose intolerance and insulin resistance, and high blood pressure.
Excess body fat at both locations has detrimental consequences for both men and women.
Obesity Continued
A waist circumference of larger than 40 inches in men or higher than 35 inches in women is a sign of increased health risk.
BMI is the recommended method for screening and monitoring the population’s body fat and for defining both overweight and obesity in a clinical setting.
For adults, a BMI of 25.0 to 29.9 is classified as overweight and a BMI of 30.0 or more is classified as obese.
Obesity Continued
Epidemiology of Obesity and Overweight: The second leading cause of preventable death in the United States is obesity.
It accounts for at least 112,000 deaths each year.
The National Center for Health Statistics reported that in 2003–2004 66 percent of U.S. adults were either overweight or obese.
Medical and Social Costs of Obesity: Direct healthcare costs refer to preventive, diagnostic, and treatment services related to overweight and obesity.
For example, physician’s office visits, hospital, and nursing home care
Obesity Continued
Medical and Social Costs of Obesity Continued
Indirect costs refer to the value of wages people lost when they were unable to work because of illness or disability.
Also includes the value of future earnings lost by premature death.
Overweight and obese individuals are at increased risk for many diseases and health conditions, including:
Type 2 diabetes
Coronary heart disease
Stroke
Obesity Continued
Sleep apnea
Respiratory problems
Some cancers
Complications during pregnancy
Complications during surgical procedures
Depression
Gallbladder disease
Osteoarthritis
Hypertension
Dyslipidemia
Obesity Continued
Determinants of Obesity: Size of the fat cells can decrease with weight loss, but the number of the cells does not decrease.
Other determinants include:
Genetics
Gender
Hypothyroidism
Cushing syndrome
Depression
Environmental: The term “obesogenic environments” includes costs, laws, policies, social and cultural attitudes, and values.
Obesity Continued
Obesity Prevention and Treatment Intervention includes the following:
Lifestyle modification
Dietary modification
Physical activity modification
Behavior modification
Public Health Policy for Addressing Global Obesity: In 2006, the Trust for America’s Health (TFAH) reported that national and state policies were inadequate for obesity control and reduction.
Obesity Continued
Obesity Prevention and Treatment Continued
Some important findings from the study include the following:
A lack of designated leadership and a bureaucratic tangle of involved agencies
Obesity and obesity-related disease rates increasing throughout the nation
All states on track to fail the national Healthy People 2010 goal of reducing the proportion of adults who are obese
Cancer
Its development involves damage to the DNA of cells.
The characteristics common to all types of cancer are uncontrolled growth and the ability to spread to distant sites (metastasize).
Link Between Cancer and Diet: It is estimated that 35 percent of the cancer mortality in the U.S. population is attributable to diet and about 80 percent to environmental factors.
Cancer Continued
Dietary components and cancer—the nutrients that may cause cancer include fat, calories, calcium, and vitamin D.
Table 10-5 presents the dietary components of cancer.
Protective Effects of Certain Food Components Against Cancer can be accomplished by eating a low-fat diet and by increasing the consumption of fruits, vegetables, and whole grains.
Cancer Continued
Fiber intake was related to the low incidence of colorectal cancer in Africans consuming high-fiber diets.
Fiber also plays a protective role in preventing breast and ovarian cancer.
Antioxidants—vitamin E, vitamin C, beta-carotene, and flavonoids are antioxidants that are active in the prevention of cancer in vitro.
Vitamins C and E and green tea can prevent the formation of carcinogenic nitrosamines and nitrosamides.
Tomatoes and tomato sauce may reduce the incidence of prostate and gastrointestinal cancers.
Cancer Continued
Physical Activity, Exercise, and Cancer: There is a direct relationship between physical activity and colon cancer.
Cancer Continued
Dietary Guidelines for Americans
Reduce fat intake to less than or equal to 30 percent of calories.
Increase fiber intake to 20–30 g/day, with an upper limit of 35 g/day.
Include a variety of vegetables and fruits in the daily diet.
Avoid obesity.
Consume alcoholic beverages in moderation, if at all.
Reduce salt-cured, salt-pickled, or smoked foods, and high-fat meats intake.
Osteoporosis
Osteoporosis is porous bone due to reduction in bone mass.
An estimated 13–18 percent, or 4–6 million, women have osteoporosis.
37–50 percent, or 13–17 million, have reduced bone mineral density (BMD).
Normal Bone Development: There are both intrinsic and extrinsic factors that are determinants of normal bone mass.
Intrinsic factors include genetics, family history, and ethnicity.
Extrinsic factors include diet, hormones, specific illness, and exercise.
Osteoporosis Continued
Calcium intake seems to increase and maintain bone mass.
The recommended daily intake for men and women aged 51 years and older is 1,200 mg elemental calcium.
Estrogen helps to preserve bone mass in young women with anorexia nervosa (AN) by impairing osteoclast-mediated bone resorption.
Oral contraceptive use by these young women in a retrospective cross-sectional study was shown to be associated with a higher BMD.
Successful Community Strategies
Nutritionists at the department of nutrition and food science at the University of Maryland conducted a research study to enhance the antioxidant content of pizza dough by:
incorporating whole wheat flour in to the dough
increasing the fermentation process and baking conditions that increased antioxidant
Chemical reactions induced by yeast during the fermentation process release antioxidants that gather in the dough.
Successful Community Strategies
A team of healthcare professionals consisting of registered dietitians, faculty, and extension specialists collaborated and designed a community-based health education program.
They also formed partnerships and coalitions with individuals, communities, organizations, government agencies, and businesses to educate people about the prevention of osteoporosis.
The program was publicized by placing advertisements in the local newspaper and displaying posters in local businesses.
Successful Community Strategies Continued
The educational session emphasized prevention, risk factors, diagnosis, and treatment of osteoporosis.
These issues were incorporated into the educational session:
Knowledge of osteoporosis, the need for an optimal calcium intake and bioavailability
Food sources of calcium; parents as role models; weight concerns; lactose intolerance; vitamin D inadequacy; calcium retention; weight-bearing exercise; bone density scans; and avoidance of smoking and excessive alcohol intake
Topics for Discussion
What are the risk factors of cardiovascular diseases?
What are the health consequences of obesity?
What are the contributing factors to obesity?
What is the link between diet and cancer?
What are the contributing factors of osteoporosis?
What are the protective effects of certain food components against cancer?
Chapter 11
Promoting Health and Preventing Disease in Older Persons
Nutrition, Longevity, and Demographics of Older Persons
Aging is a biological, psychological, and social process that most individuals will experience.
The average life expectancy at birth increased from 47 years in 1900 to 77.8 years in 2004.
Most deaths occurred after age 65.
The goal to increase life expectancy and the number of years of healthy life is known as compression of morbidity.
Nutrition, Longevity, and Demographics of Older Persons Continued
Compression of morbidity can be achieved by slowing the biological changes that accrue over time and delaying the diseases of aging.
Research suggests that a diet based on rice, fish, vegetable protein sources, fruits, vegetables, and some meat contributes to longevity.
Successful aging is trying to discover the rewards of a life fully lived to the end.
Nutrition, Longevity, and Demographics of Older Persons Continued
The four features of successful aging identified by Fisher are:
Interactions with others
Autonomy and sense of purpose
Personal growth
Self-acceptance
Nutrition, Longevity, and Demographics of Older Persons Continued
Kerschner viewed older adults as representing:
An opportunity rather than a crisis
A solution rather than a problem
An asset rather than a burden
A resource rather than a drain on resources
A group that can make social, economic, and cultural contributions
Leading Causes of Death and Disability in Older Persons
Heart disease and cancer are the leading causes of death for all persons age 65 or older and in all ethnic groups.
Other chronic health conditions are:
Cerebrovascular diseases (stroke)
Chronic lower respiratory diseases
National Goals—Healthy People 2010: The goal of the DHHS Healthy People 2010 initiative is to help individuals of all ages increase life expectancy and improve their quality of life.
Theories of Aging
The theories proposed to explain the aging process are:
Genetic
Environment
Lifestyle factors
Genetic, Environment, and Lifestyle Theory—genes determine the competence with which cells are maintained and repaired.
Theories of Aging Continued
Genetic, Environment, and Lifestyle Continued
Environmental factors include pollution, poor living conditions, lifestyle habits related to diet, smoking, alcohol abuse, and level of physical activity. These all influence the expression of the genetic code.
Free Radicals Theory—free radicals are unstable oxygen compounds formed normally during metabolism and can damage cells.
Theories of Aging Continued
Exposure to oxidizing agents such as environmental pollutants, ozone, smoking, and solar radiation can also damage the cells.
Free radicals cause oxidative damage to proteins, lipids, carbohydrates, and DNA and may indirectly destroy cells by producing toxic products.
Cell damage due to free radicals has been implicated in diseases, such as cardiovascular disease and cancer.
Theories of Aging Continued
Unstable oxygen compounds can be neutralized when they combine with an antioxidant.
Antioxidants enzymes produced by the body are catalase, glutathione, peroxidase, reductase, and superoxide dismutase.
Dietary antioxidants include selenium, vitamins E and C, and other phytochemicals.
Phytochemicals are plant substances such as beta-carotene, lycopene, and flavonoids, that contribute to normal metabolism.
Theories of Aging Continued
Caloric Restriction Theory is the nutritional model that has been successful in prolonging life in mice, rats, and other rodents.
Studies show that dietary restriction in rats increased longevity, but led to diminished sexual maturation and fertility, lower bone strength, and lower bone calcium and phosphorus contents.
The best caloric restriction approach is to add more fruits and vegetables to a diet.
Eating nutrient-dense foods and avoiding obesity enhances prospects for longevity.
Lifestyle and Socioeconomic Factors That May Influence the Aging Process
Social and economic factors affects aging and can affect the nutritional status such as:
Alcohol Use
Increased Use of Medications and Aging
Dependent Living
Income Level
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Alcohol Use: Consumption increases the risk of malnutrition in older persons.
Limit alcohol intake to no more than one drink: 4 to 5 ounces of wine or 12 ounces of beer.
Symptoms of alcoholism in older persons include trembling hands, sleep problems, memory loss, and unsteady gaity.
Thirteen percent of elderly men and 2 percent of elderly women suffer from alcoholism.
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Increased Use of Medications and Aging: Persons at highest risk for Drug Nutrient Interactions (DNI) are those that:
Take many drugs, including alcohol
Require long-term drug therapy
Have poor or marginal nutrition status
Almost half of older Americans take multiple medications daily (polypharmacy).
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Situations contributing to increased risk of DNI are:
taking more drugs for longer periods
drugs may be more toxic
variability in responding to drugs
bodies have less capability to handle drugs efficiently
poor nutritional status
making mistakes in self-care because of illness, mental confusion, or lack of drug information
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Increased Use of Medications and Aging Continued
Drugs can affect nutritional status by changing food intake patterns.
Medications may interfere with an individual’s ability to prepare meals.
Dependent Living: The number of older U.S. adults living alone increased in the past three decades.
Lifestyle and Socioeconomic Factors That May Influence the Aging Process Continued
Dependent Living Continued
Older adults that live alone are vulnerable to poverty and social isolation, which affects the quality of food intake and could lead to malnutrition.
Income Level: About 3.6 million elderly persons live below the poverty level.
The highest rates of poverty occur among the oldest of the old, minorities, women, older foreign born, persons living alone, and those with disabilities.
Food is the most flexible expense in the budget, limiting the types and amounts consumed.
Physiologic Changes That Can Affect Nutritional Status
Aging causes multiple physiologic changes that affect nutrient needs and nutritional status.
Changes in lean body mass
Aging bone
Changes in taste, smell, appetite, and digestive juices
Physiologic Changes That Can Affect Nutritional Status Continued
Changes in Lean Body Mass: Body weight decreases after age 60 in men and age 65 in women by an average of 0.5 percent yearly.
Older adults gain body fat and lose about 53 to 60 percent of total body water.
Aging Bone: a decrease in bone density. After age 40, adults lose stature with a mean height loss of 4.9 cm (1.9 inches) in women and 2.9 cm (1.1 inches) in men.
Risking osteoporosis, which is a major cause of morbidity in developed countries.
Nutrients that contribute to bone density are protein, vitamins C, D and K, phosphorous, and calcium.
Physiologic Changes That Can Affect Nutritional Status Continued
Changes in Taste, Smell, Appetite, and Digestive Juices: The secretion of digestive juices is diminished.
Gastric acid is reduced that leads to bacterial growth, causing formation of gas.
A reduction in the absorption of pH-dependent nutrients such as vitamins C, B12, B6 and folic acid.
Physiologic Changes That Can Affect Nutritional Status Continued
Changes in Taste, Smell, Appetite, and Digestive Juices Continued
A decrease in parietal cell secretion of an intrinsic factor, which binds vitamin B12 hence, impairing its bioavailability.
Sensory perceptions of taste, smell, hearing, and vision may change.
Hunger and satiety cues are fewer than in younger adults.
This type of satiety is associated with a decreased intake of one food and a switch to another food during that ingestion period.
The sensory-specific satiety mechanism promotes more variety and a more well-balanced eating, which is diminished in older persons.
Physiologic Changes That Can Affect Nutritional Status Continued
Chemosensory losses that occur with age include the following:
Ageusia: Absence of taste
Hypogeusia: Diminished sensitivity of taste
Dysgeusia: Distortion of normal taste
Anosmia: Absence of smell
Hyposmia: Diminished sensitivity of smell
Dysosmia: Distortion of normal smell
Anorexia in the Elderly
Anorexia and weight loss are common in the elderly, especially in individuals suffering from medical or mental illnesses.
The standard for monitoring body weight is the loss of 10 pounds or more over a period of 6 months or the loss of 5 percent or more of total body weight over a period of 1 year.
Anorexia in the Elderly
Failure to thrive is a syndrome in infants and children who are neglected; characterized by a failure to grow both physical and socially.
In older persons, this condition is characterized as a failure to maintain as the individual regresses in physical well-being and mental function.
Weight loss is the first major symptom of failure to thrive in older adults, plus physical disability, loss of skills for self-care, social withdrawal, diminished mental function, and death.
Water Requirements
Phillips et al. defined dehydration as losing nearly two percent of initial body weight.
This can occur after not drinking any fluid and consuming only dry foods for 24 hours.
The regulation of body water relies on thirst and an individual’s response to that thirst.
Dehydration can be diagnosed in those with high serum sodium levels (> 150 milliequivalents per liter) or a high ratio of blood urea nitrogen to creatinine (> 25).
Water Requirements Continued
The symptoms of dehydration include:
A swollen tongue
Constipation
Electrolyte imbalance
Nausea and vomiting
Hypotension
Mental confusion, sunken eyeballs
Increased body temperature and decreased urine output, pressure ulcers, and urinary tract infections
Water Requirements Continued
A general guideline of total fluid intake for older adults is 3.7 liters per day for men and 2.7 liters per day for women
Alzheimer’s Disease
The prevalence of Alzheimer’s disease varies from about 3 percent in persons age 65 years to almost 50 percent in those over 85 years.
Alzheimer’s disease begins with cognitive loss that gradually becomes worse with the extension of cerebral lesions.
Alzheimer’s disease affects many different cells involving the neurotransmitters with symptoms of memory loss, behavior and personality changes, reduced ability to think, and weight loss.
Multivitamin/Mineral Supplement
Many older persons use supplements. Supplements containing megadoses or non-nutrient substances may be toxic.
For example: Superoxide dismutase (SOD) is an enzyme that protects against oxidative damage and supposedly slows down aging can be used to treat Alzheimer’s.
Multivitamin/Mineral Supplement Continued
SOD is a protein that is broken down to amino acids in the GI tract, so oral supplements will not increase blood or tissue levels of this enzyme.
Coenzyme Q is marketed to older persons as improving the immune system; it does not boost immune function and may be dangerous for people with poor circulation.
Nutrition Screening for Older Persons
Nutrition Screening Initiative (NSI) checklist was developed to identify the risk of malnutrition among older persons.
The checklist uses the mnemonic “Determine” to help users determine poor nutritional status.
A score of 0 to 2 is considered good nutritional status, and a recheck in 6 months.
A score of 3 to 5 is moderate risk and a recheck in 3 months.
Nutrition Screening for Older Persons Continued
A score of 6 or more indicates high nutritional risk and those with that score are encouraged to see a physician, dietitian, or other health or social service.
Major indicators of poor nutritional status are shown in Table 11-5 in the text.
These can be identified through interview, observation, physical examination, anthropometric measurements, and laboratory tests.
Nutrition Screening for Older Persons Continued
Risk factors include:
Inappropriate food and nutrient intake
Poverty, social isolation
Dependency and disability
Acute or chronic diseases or conditions
Chronic medication use
Functional disability
Hunger
Living alone
Depression
Dementia
Nutrition Assessment
Older populations can be assessed using any of these forms: surveys, surveillance, screening, or interventions.
Research results show that older persons with poor dental health had lower dietary intake levels of vitamin A, carotene, folic acid, and vitamin C, and scored low on variety of diet.
A comprehensive nutrition assessment should include the ABCDs discussed in Table 11-6.
Nutrition Services That Promote Independent Living
Government programs to address nutritional needs of older adults include:
The USDA’s Food Stamp and Extension programs
Adult Day Services, Nutrition Assistance Program for Seniors (NAPS)
The Elderly Nutrition Program (ENP)
The Elderly Nutrition Program (ENP) created in 1972
Nutrition Services That Promote Independent Living Continued
The Elderly Nutrition Program provides congregate and home-delivered meals.
Meals served under the program must provide at least one-third of the Recommended Dietary Allowances.
Box 11-6 in the text presents nutrition programs for promoting health and preventing diseases in older persons.
Home Healthcare Services
Home health services can help older individuals avoid institutionalization due to illness.
About 28 percent of older persons over 65 years are unable to perform one or more Activities of Daily Living (ADLs).
12.9 percent reported difficulties with Instrumental Activities of Daily Living (IASLs) without the assistance.
Home Healthcare Services Continued
Activities for Daily Living: Older person’s ability to care for him- or herself is evaluated using ADLs and IADLs.
ADLs evaluates ability to:
Bathing oneself
Dressing oneself
Feeding oneself
Using the toilet
Home Healthcare Services Continued
IADLs evaluates ability to:
Prepare meals
Perform house-cleaning
Handle money and balance a checkbook
Shop without help
Use the telephone
Leave the house without help
Successful Community Strategies
The Seattle Senior Farmers’ Market Nutrition Program collaborated with five organizations including the University of Washington.
They supplied a market basket that contained a variety of seasonal local fresh fruits and vegetables to 480 homebound low-income seniors.
The goal was to increase the fresh fruit and vegetable intake of homebound Meals on Wheels participants.
Subjects for both the intervention and control groups were recruited via flyers that were delivered by Meals on Wheels drivers.
Successful Community Strategies Continued
The Meals on Wheels drivers volunteered to deliver the market baskets to the participants’ homes every 2 weeks.
Participants were recruited using newsletter that provided recipes for less common seasonal foods and via telephone interviews before basket deliveries.
Mailed a serving-size guide with pictures of representative foods. Participants were required to have the guide with them at the time of the telephone survey.
Discussion Topics
What are the lifestyle and socioeconomic factors that may influence the aging process?
What are the symptoms of dehydration among older adults?
What are the leading causes of death and disability in older persons?
What are the theories of aging?
What are the physiologic changes that can affect nutritional status of older persons?
Chapter 9
Nutrition in Childhood and Adolescence
Nutrition in Childhood and Adolescence
A small number of U.S. children eat the recommended amount from Food Guide Pyramid for grains, fruits, vegetables, dairy products, and meat or meat alternatives.
Majority consume high calorie-dense snacks and meals, added sugars, and larger portion sizes.
Total fat, saturated fat, and sodium intake are above recommended levels.
They consume large amounts of beverages high in added sugars (soft drinks and fruit drinks).
Nutrition Status of Children and Adolescents in the United States Continued
Healthy People 2010’s (HP) goal is to increase the proportion of adolescents who participate in daily school physical education to 50 percent.
To increase the proportion of adolescents who engage in moderate physical activity (> 30 minutes on > 5 days of the previous 7) and activity that promotes cardiorespiratory fitness three days per week.
Growth and Physical Development and Assessment: Physical growth slows down during the preschool and school years until the pubertal growth spurt of adolescence.
Nutrition Status of Children and Adolescents in the United States Continued
Growth and Physical Development Continued
By age 2, children quadruple their birth weight.
They gain an average of four and a half to six and a half pounds (2 to 3 kg) per year between the ages of 2 and 5.
Between these ages, children grow 2 1/2 to 3 1/2 inches (6 to 8 cm) in height per year.
A 1-year-old child has several teeth and digestive and metabolic systems are functioning at or near adult capability.
Nutrition Status of Children and Adolescents in the United States Continued
Eating behaviors of toddlers include:
Feeding themselves independently during the second year of life.
Using a cup, with some spilling, at 15 months.
Two-year-olds prefer fingers foods.
Playing with food and refusing any help.
Toddlers tend to be apprehensive of new foods offers about 15 times.
They are curious about new foods, but may be reluctant to try them.
See Table 9-1 for Food Guide for Toddlers and Preschoolers.
Nutrition Status of Children and Adolescents in the United States Continued
Using Surveys to Monitor Nutrient Intake: Healthy Eating Index (HEI) represents different aspects of a healthful diet.
It provides an overall picture of the type and quality of foods people eat.
Their compliance with specific dietary recommendations, and the variety in their diets.
Children ages 2 to 3 mean score for fruits and vegetables was significantly higher compared with older children’s scores.
Nutrition-Related Concerns During Childhood and Adolescence
Iron Deficiency Anemia: Many iron-deficient children come from low-income families with poor diets.
Cultural traditions and lack of nutrition knowledge for iron requirements are factors that contribute to iron deficiencies.
Iron deficiency is defined as:
Absent bone marrow iron stores
An increase in hemoglobin concentration
< 1.0g/dl after treatment with iron
Nutrition-Related Concerns During Childhood and Adolescence Continued
Iron Deficiency Anemia Continued
Other abnormal laboratory values, such as serum ferritin concentration
Children 1 to 2 years of age are diagnosed with anemia if:
Hemoglobin concentrations were < 11.0 g/dl and hematocrit < 32.9 percent.
Children ages 2 to 5 years, a hemoglobin value of 11.1 g/dl or hematocrit of 33.0 percent.
Low blood iron levels affect the child’s resistance to disease, attention span, behavior, and intellectual performance.
Nutrition-Related Concerns During Childhood and Adolescence Continued
Lead Poisoning can cause iron deficiency, and an iron deficiency can impair the body’s ability to prevent lead absorption.
Satisfactory calcium intake may slow lead’s absorption or interfere with its toxicity.
Lead poisoning is common among children under age six and can cause:
learning disabilities and behavior problems
slow growth
brain damage and central nervous system damage
Nutrition-Related Concerns During Childhood and Adolescence Continued
Strategies for preventing lead poisoning include providing:
nutritious foods
screening children for lead poisoning
preventing children from eating non-food items
avoiding water-containing lead and preventing children from putting dirty or old painted objects in their mouths
Nutrition-Related Concerns During Childhood and Adolescence Continued
Dental Caries: About 1 in 5 children ages 2 to 4 years has decay in the primary or permanent teeth.
Suggestions for reducing dental caries:
Brush teeth to remove carbohydrates from the teeth.
Rinse the child’s mouth with water.
Use fluoridated water.
Give crunchy foods such as carrot sticks and apple slices for a snack (less likely to promote tooth decay than sticky candies or raisins).
Nutrition-Related Concerns During Childhood and Adolescence Continued
Overweight and Obesity: Overweight and obesity is the accumulation of excess body fat.
Body Mass Index (BMI) between 85th and 95th percentile for age and sex is considered at risk for overweight.
BMI at or above the 95th percentile is considered overweight or obese.
Nutrition-Related Concerns During Childhood and Adolescence Continued
Factors that contribute to obesity in children and adolescents include:
the amount of television viewing
inactivity and sedentary lifestyle
genetic factors
environmental factors
cultural environment seem to play major roles in the prevalence of obesity worldwide
medical causes such as hypothyroidism and growth hormone deficiency
Nutrition-Related Concerns During Childhood and Adolescence Continued
Medical Problems Related to Childhood Obesity: Common medical problems in obese children and adolescents are hypercholesterolemia, dyslipidemia, and hypertension and can affect cardiovascular health.
The endocrine system (hyperinsulinism, insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, and menstrual irregularity)
Mental health (depression, and low self-esteem)
Some children may develop sleep apnea, liver and gall bladder diseases, osteoporosis, and some cancers
Nutrition-Related Concerns During Childhood and Adolescence Continued
Dealing with Overweight and Obesity: Childhood eating and exercise habits can be modified more easily than adult habits.
Focus on parents’ knowledge of nutrition.
Parental education should include information about low-fat foods, good physical activities, and monitoring of television viewing.
Nutrition-Related Concerns During Childhood and Adolescence Continued
High Blood Cholesterol: Atherosclerosis is a progressive, complex disease that often begins in childhood and adolescence.
Atherosclerosis is related to high serum total cholesterol levels, low-density lipoprotein, very low-density lipoprotein, and high-density lipoprotein levels.
Children and adolescents with elevated LDL-cholesterol levels, often have family members with high incidence of coronary heart disease.
Dieting Behavior and Abnormal Eating: 95 percent of individuals diagnosed with clinical eating disorders are female.
Nutrition-Related Concerns During Childhood and Adolescence Continued
Dieting Behavior and Abnormal Eating Continued
It is estimated that 0.5-1 percent of the general population suffers from anorexia, 2 percent from bulimia nervosa, and 2 percent from binge eating disorders.
Factors contributing to eating disorders:
Sociocultural pressures
Onset of bulimia nervosa usually follows a period of dieting to lose weight
Dietary restraint may contribute to bulimia
Nutrition-Related Concerns During Childhood and Adolescence Continued
Criteria for Eating Disorders
Anorexia nervosa
BMI of less than 17.5 kg/m2 in adults
Intense fear of gaining weight, and absence of anorexia nervosa
Amenorrhea for postmenarchal female
Disturbance in the way in which body size or weight is perceived
Bulimia nervosa
Recurrent episodes of binge eating
Recurrent purging behavior
Too much exercise or fasting
Self-evaluation overly influenced by body shape and weight
Nutrition-Related Concerns During Childhood and Adolescence Continued
Provisional criteria for binge eating:
Recurrent episodes of at least three behavioral and attitudinal characteristics, such as:
Eating large amounts when not physically hungry
Feeling disgusted or guilty after overeating
Eating much more rapidly than normal
Occurs on average at least 2 days a week for 6 months
Regular use of purging, fasting, and too much exercise
Malnutrition in Children
Malnutrition and hunger are responsible for nearly half of the deaths of preschool children throughout the world.
Deficiencies in vitamin A, zinc, iron, and protein results in illness, stunted growth, and limited development, and in the case of vitamin A, possibly permanent blindness.
Malnutrition in Children Continued
Malnutrition includes undernutrition, which means not consuming enough nutrients, and overnutrition, which includes excessive consumption of any particular nutrient.
Children, mainly infants and those under 5 years of age are at an increased risk for undernutrition due to increased need of energy and nutrients.
Malnutrition in Children Continued
Protein-Energy Malnutrition (PEM) occurs throughout the life cycle, but it is more common during infancy/childhood.
PEM is classified into two parts:
Primary
Secondary
In most cases, PEM is caused by a combination of both.
Malnutrition in Children Continued
Primary
Biological
Maternal malnutrition prior to or during pregnancy and lactation
Genetic factors
Sociological
Poverty
Unavailability of food
Ecological
Disasters leading to famine
Profound social inequalities either at the individual level (discrimination, refugees, prisoners) or at the community or country level
Malnutrition in Children Continued
Secondary
Biological conditions that interfere with food intake
Congenital anomalies (e.g., cleft lip)
Gastrointestinal problems that may cause malabsorption of nutrients (e.g., tropical sprue)
Genetic factors (e.g., phenylketonuria)
Biological conditions that increase energy and nutrients needs
AIDS
All infectious diseases accompanied with fever
Malnutrition in Children Continued
Secondary Continued
Other diseases that increase catabolism (e.g., tuberculosis)
Social causes
Lack of education
Inadequate weaning practices
Child abuse
Alcoholism and other drug addictions
Malnutrition in Children Continued
The Prevalence and Effect of Malnutrition in Children in the United States: About 13 million children live in families with incomes below the federal poverty level.
About 20 percent of children under 6 years old live in poor families.
Approximately 17.8 percent of the children 6 years or older live in poor families.
About 15.6 percent of households with children under 6 years old were food-insecure.
Children and Adolescents with Special Healthcare Needs/Childhood Disability
The prevalence of childhood disability is increasing: about 7–18 percent of children and adolescents ages birth to 18 years in the United States have a chronic physical, behavioral, developmental, or emotional condition.
There are various causes of developmental disabilities and special healthcare needs are comprehensive.
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
They may have physical impairments, developmental delays, or chronic medical conditions that are caused by or related with these factors:
Genetic conditions (diabetes, sickle cell anemia, etc.)
Congenital infections
Inborn errors of metabolism (phenylketouria, lactose intolerance, galactosemia, etc.)
Prematurity
Neural tube defects
Maternal substance abuse
Environmental toxins (lead mercury, etc.)
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
Nutrition risk factors may be physical, biochemical, psychological, or environmental in nature.
Physical conditions such as a cleft lip or palate.
Biochemical conditions such as:
A disease process such as galactosemia may limit an individual’s ability to feed, digest, or absorb food.
Drug nutrient interactions may alter digestion, absorption or the bioavailability of nutrients from the diet.
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
Psychological conditions such as depression or stress that may alter an individual’s appetite and motivation to follow a specified diet plan.
Environmental factors such as:
Family and social support
Finances
To receive the nutrition benefits, the child must have a diet prescription from a physician.The prescription must include:
A statement identifying the disability and how the disability affects the adolescent’s diet.
Children and Adolescents with Special Healthcare Needs/Childhood Disability Continued
The prescription must include (continued):
A statement identifying the major life activity affected by the disability.
A specific list of dietary changes, modifications, or substitutions required for the diet.
The Effect of Television on Children’s Eating Habits
Children watch an average of 3 hours of advertisements per week and 19,000 to 22,000 commercials over a 1-year period.
Children from families with high-television use consume an average:
6 percent more of their total daily energy intake from meats
5 percent more from pizza, salty snacks, and soda
About 5 percent less of their energy intake from fruits, vegetables, and juices than children from families with low-television use
Nutrition During Childhood and Adolescence
Nutrients most likely to be low or deficient are calcium, iron, zinc, vitamin B6, and vitamin A.
Children living in poor families are more likely to consume diets that are low in calories; vitamins A, C, E, and B6, folate, iron, zinc, thiamin, and magnesium.
Growth and Development during puberty:
Height and weight increase.
Many organ systems enlarge.
Increase in lean body mass and changes in the distribution of fat.
Nutrition During Childhood and Adolescence Continued
Growth and Development Continued
Normally, growth spurts begin between ages 10.5 and 11 for girls, and peak at about 12 years of age.
Boys’ growth spurts start between 12.5 and 13 and peak at about age 14. This spurt lasts about two years.
The most rapid linear growth spurt for an average boy occurs between 12 and 15 years of age.
Nutrition During Childhood and Adolescence Continued
During adolescence:
Boys gain more weight than girls.
Boys experience greater increases in lean body mass.
Girls accumulate more body fat.
Specifically around the hips and buttocks, upper arms, breasts, and upper back.
Nutrition During Childhood and Adolescence Continued
Adolescent Eating Behaviors are not static; they fluctuate throughout adolescence.
They may use foods to establish individuality and to express their identity.
Experimentation may lead to certain eating behaviors such as skipping meals.
Breakfast is the most-skipped meal.
Reasons for their change in eating habits.
Spending less time with family and more time with their peer group.
Nutrition During Childhood and Adolescence Continued
They eat more meals and snacks away from home, including many fast foods high in fat and calories.
The average teenager eats at fast food restaurants twice a week.
Fast-food visits account for 31 percent of all food eaten away from home and make up 83 percent of their visits to restaurants.
Food and Nutrition Programs for Children and Adolescents
National School Lunch Program was established in 1946 and is under the direction of the USDA.
Children at or below 130 percent poverty level are eligible for a free lunch.
School Breakfast Program began as a pilot project in 1966 and was made permanent in 1975.
Special Milk Program was established in 1955 by USDA.
Summer Food Service was established in 1975 after a pilot program in 1968.
Food and Nutrition Programs for Children and Adolescents
Team Nutrition Program started in 1995 by USDA.
To “improve the health and education of children through better nutrition.”
Head Start was established in 1965 program for children between the ages of 3 and 5 for low-income families.
Provides education, health services (medical, nutritional, dental, and mental health), and social services.
National Youth Sports Program (NYSP) is a federal program designed to assist low-income children ages 10 to 16 in a summer program.
Challenges to Implementing Quality School Nutrition Programs
School meals face a variety of challenges:
Students’ preferences for fast foods, soft drinks, and salty snacks
Mixed messages sent by school personnel
School food preparation and serving space limitations
Inadequate meal periods
Lack of education standards for school food service directors
Challenges to Implementing Quality School Nutrition Programs Continued
Promoting Successful Programs in Schools: Encouraging healthful behaviors may be achieved through implementation of a Coordinated School Health Program (CSHP).
A CSHP would combine health education, disease prevention, health promotion, and access to health and social services in an integrated comprehensive manner.
Successful Community Strategies
As a pilot project for the San Francisco Unified School District (SFUSD), Aptos Middle School made changes in its vending and à la carte food service programs.
The purpose of the project was to establish nutrition standards for competitive foods.
The principal, a physical education program, and a group of parents, teachers, and volunteers initiated the change in the food service program.
This group met electronically (via e-mail) to share concerns and data and to attain a consensus.
Successful Community Strategies Continued
Changes instituted included:
Removed soft drinks from the vending machines located in the physical education department and replaced with bottled water.
Fruit options for students were expanded beyond apples, oranges, and bananas to include kiwifruit, grapes, strawberries, and melons.
Jicama, raw broccoli, spinach, and romaine lettuce were available for salads.
Soft drinks were removed from the à la carte line in the cafeteria and replaced with water, milk, and 100-percent juice (no more than 12 ounces per serving)..
Successful Community Strategies Continued
High-fat foods, such as French fries and nachos, were removed from cafeteria meals.
High-fat/high-sugar foods were removed from the à la carte line and replaced with fresh, healthier options and more appropriate portion sizes.
The new food options included turkey sandwiches, sushi, homemade soup, salads, and baked chicken with rice.
Vending machines, and any other food sold outside cafeterias adhered to these standards.
Topics for Discussion
What are the nutrients most likely to be deficient in school-age children and adolescence?
What are the causes of PEM?
What are the nutrition-related risk factors for children and adolescents with special healthcare needs?
What are some of the challenges facing school meal programs?
What are the eating behaviors of adolescents and toddlers?
What are the contributing factors to eating disorders and the difference between bulimia and anorexia nervosa?
Chapter 18
Private and Government Healthcare Systems
Private and Government Healthcare Systems
In the United States, health insurance coverage is generally classified as either private (non-government) coverage or government-sponsored coverage.
Healthcare Coverage vs. Uninsured
The National Center for Health Statistics defines health insurance as public and private payers who cover medical expenditures incurred by a defined population in a variety of settings.
In the United States, the risk of becoming uninsured increases significantly for those earning low wages, the unemployed, and when employers are unable to provide insurance to workers.
Table 5-2 presents the trend of declining health insurance coverage.
Private Health Insurance
The concept of insurance is to combine the healthcare experiences of many enrollees in order to reduce expenses for any one individual to a manageable prepayment amount.
Employment-Based Plans is coverage offered through one’s own employment or a relative’s employment.
It may be offered by an employer or by a union.
Private Health Insurance Continued
Direct-Purchase/Fee-For-Service Plans are the traditional type of healthcare policy.
The physician sets a price for each type of service delivered, and then the client or insurance company pays the fee.
This type of health insurance provides the most choices of doctors and hospitals.
Private Health Insurance Continued
The two kinds of fee-for-service coverage are basic and major medical.
Basic covers some hospital services and supplies, such as X-rays and prescribed medicine.
Major medical insurance covers the cost of long-term, high-cost illnesses or injuries plus whatever basic did not cover.
Private Health Insurance Continued
Group Contract Insurance—to make hospitals and physicians products and services affordable to ordinary people in the United States.
With unmanaged care (fee-for-service) payments, healthcare providers could increase the number of single services they deliver in order to increase profit.
Private Health Insurance Continued
Managed Care—manages the cost and delivery of healthcare services, the quality of that healthcare, and access to care.
Managed care influences how much healthcare clients can use.
Health Maintenance Organizations (HMOs) are prepaid health plans.
The goal of an HMO is to provide affordable, well-organized healthcare by allowing clients to prepay (capitation payment) on a regular monthly basis for all services provided.
Private Health Insurance Continued
Including physicians’ visits, hospital stays emergency care, surgery, laboratory (lab) tests, X-rays, and therapy for all members and their families.
There may be a small co-payment for each office visit, such as $15 for a doctor’s visit or $50 for hospital emergency room treatment.
Private Health Insurance Continued
Point-of-Service Plans (POS) offer enrollees the option of receiving services from participating or nonparticipating providers.
The primary care physicians in a POS plan usually make referrals to other providers in the plan.
If the physician makes a referral out of the network, the plan pays all or most of the bill.
If the client refers him or herself to a provider outside the network the co-payment and deductibles would increase.
Private Health Insurance Continued
Preferred Provider Organizations (PPOs) are a combination of traditional fee-for-service and an HMO.
A PPO requires that the clients choose a primary care physician to monitor their healthcare.
If the client decides to choose a physician that is not part of the plan, the client will pay a larger portion of the bill.
If the client’s physician is not a part of the network, he or she will not be required to change physicians to join a PPO.
Government Health Insurance/
Public Insurance
Government health insurance includes plans funded by governments at the federal, state, or local level.
The federal agency Centers for Medicare and Medicaid Services (CMS) administers the programs.
The Medicare Program—Title XVIII of the Social Security Act is the designated health insurance for the aged and disabled.
Government Health Insurance/
Public Insurance Continued
Medicare consists of two parts:
Hospital Insurance (HI), also known as Part A
Supplementary Medical Insurance (SMI), known as Part B
Part C, sometimes known as the Medicare Advantage program, was established as the Medicare+Choice program.
Part D, a prescription drug benefit that became available in 2004
Government Health Insurance/
Public Insurance Continued
Part A Coverage is provided automatically and is free of premiums to persons age 65 or over who are eligible for Social Security or Railroad Retirement benefits.
Provided to insured workers with ESRD (and to insured workers’ spouses and children with ESRD), and ineligible aged and disabled beneficiaries who voluntarily paid a monthly premium for their coverage.
Government Health Insurance/
Public Insurance Continued
Part B Coverage covers physicians’ and surgeons’ services, chiropractors, podiatrists, dentists, and optometrists.
Covers services provided by Medicare-approved practitioners such as:
Dietitians
Certified registered nurse anesthetists, clinical psychologists
Clinical social workers (other than in a hospital)
Physician assistants, and nurse practitioners and clinical nurse specialists
Government Health Insurance/
Public Insurance Continued
Coverage Gaps include:
Medicare deductibles
Co-payments
Excess charges by doctors who do not accept Medicare assignments
Medical services and supplies that Medicare do not cover
Government Health Insurance/
Public Insurance Continued
Medigap provides extra protection beyond Medicare.
Medigap is a type of private insurance coverage that may be purchased by an individual enrolled in Medicare.
Part D provides subsidized access to prescription drug insurance coverage upon payment of a premium individuals entitled to Part A or Part B.
Government Health Insurance/
Public Insurance Continued
The Medicaid Program is the largest source of funding for medical and health-related services for poor people.
Within broad national guidelines each state must:
establish its own eligibility standards
determine the type, amount, duration, and scope of services
set the rate of payment for services
administer the program
Government Health Insurance/
Public Insurance Continued
Basis of Eligibility—individuals are usually eligible for Medicaid if they:
meet the requirements for the AFDC
are less than 6 years of age with family income at or below 133 percent
are pregnant women with family income below 133 percent of the FPL
are Supplemental Security Income (SSI) recipients, etc.
Government Health Insurance/
Public Insurance Continued
Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA)—known as “welfare reform” bill.
Welfare reform repealed the open-ended federal entitlement program known as Aid to Families with Dependent Children (AFDC) and replaced it with Temporary Assistance for Needy Families (TANF).
TANF limits a family’s lifetime cash welfare benefits to a maximum of 5 years.
Government Health Insurance/
Public Insurance Continued
State Children’s Health Insurance Program (SCHIP) covers individuals who have incomes too high to qualify for state medical assistance but cannot obtain private insurance.
Those who can qualify are:
children in low-income families
eligible children under the age of 19 whose state provides 12 months of continuous Medicaid coverage
Government Health Insurance/
Public Insurance Continued
Medicaid, Title XIX of the Social Security Act offers medical assistance for certain basic services to most categorically needy populations.
Box 5-1 presents services generally provided by the state Medicaid programs.
Government Health Insurance/
Public Insurance Continued
Balanced Budget Act includes a state option known as Programs of All-inclusive Care for the Elderly (PACE).
The PACE team offers and manages all health, medical, and social services.
Successful Community Strategies
The Illinois Department of Human Services integrated WIC with two state-funded programs:
Family Case Management (FCM) and Targeted Intensive Prenatal Case Management (TIPCM)
Integration of these programs allowed them to operate more efficiently.
For example, staff members of many local health departments were trained to provide both WIC and FCM services.
Topics for Discussion
How does poverty limit access to healthcare?
What is the difference between Aid to Families with Dependent Children (AFDC) and Temporary Assistance for Needy Families (TANF)?
Who does SCHIP cover?
What is the difference between Medicare and Medicaid?