Healthy Aging: Approaches to Reduce Chronic Disease Risk

Transcription

1 Healthy Aging: Approaches to Reduce Chronic Disease Risk Alice H. Lichtenstein, D.Sc. Gershoff Professor of Nutrition Science and Policy Tufts University

2 Overview Chronic disease risk in older adults Societal influences on eating behaviors Nutrient supplement use in older adults Approaches to provide dietary guidance to older adults

3 Chronic Disease CDC Definition Heart disease Stroke (hypertension) Type 2 diabetes Obesity Cancer Arthritis

4 Chronic Disease Deaths - White Males and Females (2008) Rogers VL, et al. Circulation 2012;125:e2-e220

5 Chronic Disease Deaths Black Males and Females (2008) Black Females Black Males Rogers V, et al. Circulation 2012;125:e2-e220

6 Incidence of CVD (Framingham Heart Study, ) Rogers V, et al. Circulation 2012;125:e2-e220

7 Chronic Disease Risk Factors Cardiometabolic Syndrome Dyslipidemia (high LDL-C and low HDL-C) Hypertension High waist circumference Elevated blood glucose concentrations Response similar among age categories Cumulative effect through the lifecycle

8 Chronic Disease CDC Definition Heart disease Stroke (hypertension) Type 2 diabetes Obesity Cancer Arthritis

9 Overview Chronic disease risk in older adults Societal influences on eating behaviors Nutrient supplement use in older adults Approaches to provide dietary guidance to older adults

10 Environmental Influences on Eating Behaviors Portion Sizes (% change) 1989 to 1996 Soft drinks 12% Crackers 14% Cookies 12% Ready-to-eat cereal 10% Pasta 12% Pizza -14% French fries 8% Smiciklas-Wright et al. JADA 2003;103:41

11 Portion Size Drift Fried Potatoes Size 1998 (oz or fl oz) Size 2002 (oz or fl oz) Size 2006 (oz or fl oz) McDonald's 2.4 Small 2.4 Small 2.4 Small 5.3 Large 5.3 Medium 4.0 Medium 6.3 Supersize 6.3 Large 6.0 Large 7.1 Supersize Wendy's 3.2 Small 3.2 Kids' meal 3.2 Kids' meal 4.6 Medium 5.0 Medium 5.0 Small 5.6 Biggie 5.6 Biggie 5.6 Medium 6.7 Great Biggie 6.7 Great Biggie 6.7 Large Young LR, Nestle M. J Public Health Policy 2007;28, 238

12 Portion Size Drift Cola Beverage Size 1998 (oz or fl oz) Size 2002 (oz or fl oz) Size 2006 (oz or fl oz) McDonald's 12 Child 12 Child 12 Child 16 Small 16 Small 16 Small 21 Medium 21 Medium 21 Medium 32 Large 32 Large 32 Large 42 Supersize Wendy's 12 Kid 12 Kid 12 Kid 16 Small 16 Small 20 Small 22 Medium 20 Medium 32 Medium 32 Biggie 32 Biggie 42 Large 6.7 Great Biggie 6.7 Great Biggie 6.7 Large Young LR, Nestle M. J Public Health Policy 2007;28, 238

13 Environmental Influences on Eating Behaviors Expanding food supply; Per capita energy availability increased 15% between 1970 and Ann Rev Public Health 2001;22:309

14 Societal Temporal Challenges Changes Associated in With Energy Eating Intake Behaviors NHANES ( 71-75) NHANES ( 05-06) All < >30 Austin G L et al. Am J Clin Nutr 2011;93:

15 Environmental Influences on Eating Behaviors

16 Societal Calories Challenges Per Unit Cost Associated (Kcal/$) for With Major Eating Food Behaviors Groups Drewnowski A, Am J Clin Nutr 2010;91:1095S-1101S

17 Environmental Influences on Eating Behaviors Eating out; Eating in fast-food and other restaurants increased by 200% and 150%, respectively, between 1974 and Ann Rev Public Health 2001;22:309

18 Barnard, N. D. Am J Clin Nutr 2010;91:1530S-1536S Food Expenditures Share of Disposable Personal Income Food expenditures (% disposable income)

19 Environmental Influences on Eating Behaviors Advertising; Food most heavily advertised are those with marginal nutritional value (i.e. sweets, snacks, pre-sweetened cereals, soft drinks)

20 Societal Challenges Associated With Eating Behaviors

21 Societal Challenges Associated With Eating Behaviors Liquid calories - soda; In 1970 about 25 gallons per person per year. This figure has doubled to 50 gallons/person/year by Ann Rev Public Health 2001;22:309

22 Environmental Influences on Eating Behaviors Fad Diets First Law of Thermodynamics Total inflow of energy into a system must equal the total outflow of energy from the system, plus the change in the energy contained within the system.

23 Fad Diets NO dieting or pills NO prepackaged meals NO exercise required NO failures guaranteed! Learn More Detox Detoxification is the secret tool you can use to boost weight loss. Many of us are toxic, holding wastes and even parasites, that hinder our weight loss goals. Learn how to detox safely and you can experience easier weight loss than ever before. Zone Diet The key factor in Zone Diet is the hormonal balance you achieve while eating each skillfully prepared meal. With a food plan comprising an accurate balanced ratio of carbohydrates (40%), fat (30%) and proteins (30%); you actually get to eat foods, which control your body s insulin production. This means that no meal or snack is forbidden in the Zone Diet and yet you can lose weight or fat while Zone dieting.

24 Percent of Obese (BMI > 30 in U.S. Adults) 2010

25 High Protein Diets 1972

26 Potential High Protein Options

27 Potential High Protein Options X X X

28 Low Fat Diets 1994

29 Potential Low Fat Options

30 Potential Low Fat Options

31 Low Carbohydrate Diets

32 Potential Low Carbohydrate Options

33 Potential Low Carbohydrate Options

34 Overview Chronic disease risk in older adults Societal influences on eating behaviors Nutrient supplement use in older adults Approaches to provide dietary guidance to older adults

35 Nutrient Supplements and Older Adults Nutrient supplement use is more prevalent in older than younger adults

36 Prevalence Dietary Supplement Use Past Month ( NHANES) Age (F+M) years Any nutrient MV/MM* supplement percent ± 2 30 ± ± 2 37 ± 2 >60 63 ± 2 40 ± 2 * MV = multi-vitamin MM = multi-mineral Radimer K, et al. Am J EPi 2006;339:349

37 Prevalence Dietary Supplement Use Past Month ( NHANES) Age (F+M) years Any nutrient supplement MV/MM percent Botanical ± 1 27 ± 1 13 ± ± 1 35 ± 1 18 ± ± 2 44 ± 2 20 ± ± 1 46 ± 2 17 ± 1 Bailey RL, et al. JN 2011;141:261

38 Prevalence Dietary Supplement Use Past Month ( NHANES) Females years Any nutrient supplement MV/MM percent Botanical ± 2 30 ± 1 13 ± ± 2 38 ± 2 21 ± ± 2 48 ± 2 21 ± ± 2 48 ± 2 16 ± 1 Bailey RL, et al. JN 2011;141:261

39 Prevalence Dietary Supplement Use Past Month ( NHANES) Males years Any nutrient supplement MV/MM percent Botanical ± 2 25 ± 2 14 ± ± 1 32 ± 1 16 ± ± 2 40 ± 2 18 ± ± 2 43 ± 2 18 ± 1 Bailey RL, et al. JN 2011;141:261

40 Overview Chronic disease risk in older adults Societal influences on eating behaviors Nutrient supplement use in older adults Approaches to provide dietary guidance to older adults

41 Approaches to Provide Dietary Guidance to Older Adults Why do we need to think differently about providing nutrition information to older adults? shift in nutrition related concerns over their lifetimes (excess rather than deficiency) food purchasing and preparation patterns established awareness of available nutrition information may be lower technology literacy may be lower

42 Providing Nutrition Information to Older Adults Russell R, Rasmussen H, Lichtenstein A.H. Nutr. 1999; 129:

43 Providing Nutrition Information to Older Adults Lichtenstein AH, et al. J Nutr. 2008; 138:78-82

44 Providing Nutrition Information to Older Adults

45 Changing Food Choices Healthy Lunches Experimental Instructional Approaches Group 1 - Discussion-Decision (interactive) Group 2 - Lecture (passive audience) Group 3 - Control

46 Changing Food Choices Healthy Lunches Experimental Instructional Approaches Group 1 49% increase Group 2 31% increase Group 3 10% increase Radke M & Caso EK JADA 1948;24:23

47 Nutrition Labeling Fresh Meat New USDA Nutrition Labels for Meat, Poultry More Nutrition Info on Ground Meat/Poultry and Popular Cuts by Daniel J. DeNoon WebMD Health News March 1, 2012

48 Nutrition Labeling Fresh Meat Beef, ground 90% lean/10% fat, raw Beef, ground 70% lean/30% fat, raw

49 Nutrition Labeling Fresh Meat Beef, ground 90% lean/10% fat, raw Turkey, ground 92% lean/8% fat, raw

50

51

52 Potential Solutions Commentary Bring Back Home Economics Education Alice H. Lichtenstein and David S. Ludwig JAMA. 2010;303:1857

53 Overview Chronic disease risk in older adults Societal influences on eating behaviors Nutrient supplement use in older adults Approaches to provide dietary guidance to older adults

54