Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
CHAPTER 13 CONCEPTS u s t A Ta s t e
J
■ Eating patterns can affect health and nutrition throughout life.
■ Children’s nutrient intakes must meet their needs for growth and
development as well as for maintenance and activity.
■ Normal growth is the best indicator of adequate intake.
■ Sexual maturation affects nutrient needs. Does a child’s diet affect their risk
■ Eating disorders and the use of fad diets, sports supplements, of heart disease as an adult?
and alcohol use all increase during adolescence.
■ Americans are living longer than ever before; good nutrition can
Can fast food and sweetened cereals
help to increase the number of healthy years. be part of a healthy diet?
■ The physiological, social, and economic changes that occur with Can a healthy diet keep you young?
aging increase the risk of malnutrition.
■ Older adults need to consume nutrient-dense diets to meet nutrient Does getting older increase your risk
needs without exceeding their calorie needs. of malnutrition?
■ Alcohol consumption can affect nutritional status, judgment,
and health.
Nutrition from 13
2 to 102
Good Nutrition Early On Is Key
to Health Throughout Life
INTRODUCTION
Healthy Eating Habits Keep Children Healthy
Healthy Eating Habits Are Learned The Orlando Sentinel
Nourishing Young Children Can
Be a Challenge See How They Run Ocoee
Children’s Energy and Nutrient Needs Increase
with Age Elementary. . . .
A Balanced Varied Diet Will Meet Children’s
Nutrient Needs By Kate Santich
Normal Growth Is the Best Indicator
of Adequate Intake
April 12, 2004 . . . At a time when childhood obesity is a
Diet and Lifestyle Affect Nutritional Risks in Children national crisis, when kids are casualties in an epidemic of
type 2 diabetes and high blood pressure, tiny Ocoee
Adolescents Have Changing Bodies
and High Nutrient Needs Elementary School has become a microcosm of hope.
Hormones Cause Sexual Maturation and Changes Professionals from the Health Central Foundation have
in Body Size and Composition teamed with teachers and administrators to spread the
Total Energy and Nutrient Needs Are Greatest gospel of healthy living—regular exercise, good eating
during Adolescence habits, taking care of yourself. . . .
Teens Must Learn to Make Healthy Choices
to Meet Nutrient Needs In January, the entire elementary school—nearly 600
Concerns about Appearance and Performance Can students, kindergarten through fifth grade—launched a
Precipitate Nutritional Problems “wellness challenge.” They walk or run at least once a week,
Good Nutrition Can Keep in addition to other exercise. In the classroom, they learn
Adults Healthy about the food pyramid and the importance of eating fruits
Aging Begins at Birth and vegetables. On the school’s morning announcements,
Aging Affects Recommendations for Some Nutrients guest speakers talk about drinking water instead of soda and
The Physical, Mental, and Social Changes of Aging
Increase Nutritional Risks sum up the latest health findings on children.
The DETERMINE Checklist Helps Assess the Risk No one is chastised for being out of shape. The word
of Malnutrition “diet” is never uttered. The idea is to inspire, not ridicule.
Meeting Nutritional Needs Involves Nutritional, Social,
and Economic Considerations And parents are encouraged to join in as well.
Drinking Alcohol Can Be a Risk To read the entire article, go to www.orlandosentinel.com/.
at All Stages of Life
Alcohol Enters the Bloodstream Quickly
Long-Term Excessive Alcohol Consumption Has Serious
Health Consequences
There Are Benefits to Moderate Alcohol Consumption
If You Drink Alcohol Do So in Moderation
hy does it matter if you eat doughnuts for
W
breakfast and french fries for lunch when
you’re 8 years old? It doesn’t, if you do it oc-
casionally, but a diet based on foods like
these that are high in calories and low in nu-
trients can affect your growth and increase your risk of de-
veloping obesity, heart disease, or diabetes as a child and
later on in life. Unfortunately most 8-year-olds, and other
children and adolescents in the United States today, are eat-
ing doughnuts for breakfast, french fries for lunch, burgers
and shakes for dinner, and sodas and chips for snacks a lot
more often than is healthy.
441
442 Chapter 13 Nutrition from 2 to 102
cholesterol levels higher than this. Elevated blood cholesterol levels during child-
hood and adolescence are associated with higher blood cholesterol and higher mor-
tality rates from cardiovascular disease in adulthood. The American Academy of
Pediatrics recommends blood cholesterol monitoring for high-risk children and
teenagers. This includes those with parents or grandparents who developed heart
disease before age 55, and those whose parents have cholesterol levels over 240 mg
per 100 ml. A child who eats a poor diet has
an increased risk of developing
Higher blood pressure in childhood leads to hyperten- elevated blood cholesterol, blood
sion later Children who have blood pressure at the high end of normal are
sugar, and blood pressure levels,
more likely to develop high blood pressure as adults. High blood pressure increases
the risk of stroke, heart disease, and kidney disease. As with adults, blood pressure
all of which increase the risk
can be affected by the amount of body fat, activity level, and sodium intake, as well of developing heart disease in
as by the total pattern of dietary intake. So, even in childhood, a diet that meets but adulthood. On the other hand,
doesn’t exceed nutrient recommendations and includes plenty of exercise can help a healthy diet in childhood can
prevent hypertension. This is particularly important if there is a family history of delay or prevent the onset of
hypertension. heart disease.
100
90
80
Poor diet
70
60
Percent Needs
of improvement
50
children
in the
United 40
States
30 Good diet FIGURE 13.2
20 This graph shows us the percentage of U.S. children between the ages of 2 and 18 who
have a good diet, a diet that needs improvement, and a poor diet. The classification is
10 based on the Healthy Eating Index. A Healthy Eating Index score of 80 out of 100 is
considered a good diet, a score between 51 and 80 is classified as a diet that needs
0 improvement, and a score less than 51 indicates a poor diet. As children grow older, the
2–5 6–12 13–18 percentage that eats a good diet decreases. (U.S. Department of Agriculture, Center of
Age (years) Nutrition Policy and Promotion. Continuing Survey of Food Intakes by Individuals, 1996)
444 Chapter 13 Nutrition from 2 to 102
Nourishing a growing child is not always an easy task. The diet must supply the nutrients
needed for growth and development as well as for maintenance and activity. It must be
appropriate for their stage of physical development and it must suit their developing
tastes. Many factors other than nutrient needs determine which foods a child consumes.
3000 Key
Males
Females
2000
Energy needs
(Cal/day)
1000
0
60
50
Protein needs 40
(g/day)
30
20
FIGURE 13.3 10
0
The need for both energy and protein 2 6 16
increases with age. Age (years)
Nourishing Young Children Can Be a Challenge 445
FIGURE 13.4
Choose a diet that is low in
saturated fat and cholesterol The Dietary Guidelines recommend that everyone over the
and moderate in total fat age of 2 years consume a diet that is low in saturated fat
and cholesterol and moderate in fat. (USDA, DHHS, 2000)
carbohydrate in a child’s diet should be from whole grains, fruits, and vegetables.
These will help to provide the recommended amount of fiber. Fiber supplements are
not recommended for children because high intakes can fill them up, limiting the
amount of food and, consequently, the nutrients that a small child can consume.
Foods high in added sugars, such as cookies, candy, and soda, should be limited.
Most children consume enough fluids but too much salt
By 1 year of age, a child’s kidneys have matured and the water lost through evapora-
tion has decreased, so fluid losses decline. As with adults, under most situations,
drinking enough to satisfy thirst will provide sufficient water. In children 1 to 3 years
of age about 1.3 liters (5 1/2 cups) of fluid daily will meet needs; about 4 cups of this
should be from water and other fluids and the rest from food. Older children, ages 4
to 8, need about 1.7 liters (7 cups) of fluid per day.7 These needs increase when the
environmental temperature is high or activity increases sweat losses.
The typical sodium intake in children and teens currently exceeds the recom-
mended amount. A UL of 2.3 grams of sodium per day has been set for adults and
A low vitamin D intake may be
teens 14 to 18 years of age, because a high sodium intake is associated with elevated
putting children’s bones at risk.
blood pressure. The UL is somewhat lower in children and younger teens.7
Recently, rickets due to vitamin D
Adequate calcium is essential for maximizing peak bone deficiency has been appearing
mass Adequate calcium intake during childhood is essential in order to develop among urban children who have
strong, dense bones; the greater the bone density, the lower the risk of developing os- dark skin, get little sun exposure,
teoporosis later in life (see Chapter 9). The AI for calcium for toddlers is 500 mg per and consume vegetarian diets.
day and for young children is 800 mg per day. Despite the importance of calcium for When sun exposure is limited,
maximizing peak bone mass, calcium intake in school-age American children is de- dietary vitamin D becomes more
clining, primarily due to a decrease in the consumption of dairy products, such as important in meeting needs.
milk, yogurt, and cheese. Only 79% of girls and 89% of boys ages 2 to 8 consume the
recommended amount of calcium.8 (See Your Choice: No Bones About It?) For more information on
calcium and health go
Iron deficiency is common in children Iron deficiency anemia is to the Milk Matters
one of the most prevalent forms of malnutrition in children. Although iron intake by Web site of the National
American children has increased over the last 20 years, iron deficiency is still a public Institute of Child Health
health problem.9 Iron deficiency anemia can lower a child’s resistance to illness and and Human Development at
slow recovery time. It can affect learning ability, intellectual performance, stamina, www.nichd.nih.gov/milk/milk.cfm
and mood. Good sources of iron that are acceptable to small children include fortified
grains and breakfast cereals, raisins, eggs, and lean meats. If anemia is diagnosed, iron
supplements are usually prescribed until iron stores are replenished. These supple-
ments should be kept out of the reach of children. Overdoses of iron-containing sup-
plements are the leading cause of poisoning deaths among children under 6 years of
age.10 To help protect children, products containing iron include a warning about the
hazards to children of ingesting large amounts of iron. Products containing 30 mg or
more per dose are packed in individual doses to reduce the chances of consuming
enough to cause toxicity.
446 Chapter 13 Nutrition from 2 to 102
A&D
1g
Total Fat
added
Total Carbohydrate 1g
Fiber 0g
Sugars 2g
Protein
Infants Children
0-1 1-4
% Daily Value 6%
Low-fa
15% 10%
Calcium 45% 60%
Iron 15% 8%
Vitamin E
t
45% 30%
Thiamin 45% 30%
Riboflavin 25% 20%
Niacin 15% 10%
PIECE IT TOGETHER
▼
The nurse weighs and measures Alex and draws a blood
sample to check for iron deficiency anemia. She compares Dairy products are an important source of protein, vitamins,
Alex’s weight for height to last year’s measurements. Last and minerals, particularly calcium, but they are a poor
year he was at the 50th percentile, and he is now almost at source of iron. In addition, the high calcium they provide
the 75th percentile. decreases absorption of iron consumed at the same meal.
The pediatrician reports that Alex is anemic again and S UGGEST SOME DIETARY CHANGES THAT WOULD
prescribes an iron supplement. She also refers Alex and his INCREASE A LEX ’ S IRON INTAKE AND ABSORPTION .
parents to a dietitian for counseling on iron intake and
weight management. The dietitian reviews Alex’s diet and ▼
exercise patterns. She learns that he has been watching TV Your answer:
or playing video games for about 6 hours a day. Below are
the responses she gets when she asks Alex about how often
he consumes certain foods:
H OW CAN A LEX REDUCE THE
Servings/ Servings/ ENERGY CONTENT OF HIS DIET ?
Food Day Week ▼
Milk and
dairy products: Whole milk 6 Because Alex is well past the age when he needs a high-fat
Meat and eggs: Red meat 1 diet for growth and development and his weight is increasing
Chicken 2 more rapidly than his height, the dietitian recommends that
Fish 1 he switch to low-fat milk and dairy products. The dietitian
Eggs also suggests that the family make some changes in the
Grains and Whole grains 2 types of food they have around the house so Alex can have
cereals: Refined grains 4 nutrient-dense choices such as fruits and vegetables to replace
Fruit and juices: Citrus 1 the candy and chips he currently snacks on. The dietitian
Other 2 encourages the family to bake, broil, or grill their meat,
Vegetables: Dark green leafy trimming off excess fat. She also recommends the family
Other 1 work together to increase the amount of exercise they get.
Added fats: 3
TO HELP A LEX INCREASE HIS ACTIVITY LEVEL SUGGEST
Snack foods: Chips, etc. 1
SOME ACTIVITIES AN 8- YEAR - OLD BOY MIGHT ENJOY.
Candy 1
▼
W HAT NUTRIENTS ARE LIKELY TO BE EXCESSIVE Your answer:
OR DEFICIENT IN THIS DIETARY PATTERN ?
▼
Alex’s high intake of regular dairy products provides a good
source of calcium but adds a lot of fat and saturated fat to
his diet. His low intake of meats and leafy green vegetables
means his iron intake is probably low. His low intake of
448 Chapter 13 Nutrition from 2 to 102
TABLE 13.1
A Typical Day’s Food Intake for 3- and 8-Year-Old Children
Amount
Food 3-yr-old 8-yr-old
Breakfast
Corn flakes 3 Tbsp 3/4 cup
Milk, 2% 1/2 cup 3/4 cup
Banana 3 Tbsp half
Snack
Peanut butter 1 Tbsp
Wheat crackers 3
Apple juice 1/2 cup
Lunch
Vegetable soup 1/4 cup 1 cup
Grilled tuna sandwich half 1
Tomato 1/4 1/2
Milk, 2% 1/2 cup 3/4 cup
Snack
Hot cocoa 1/2 cup 3/4 cup
Peanut butter and jelly sandwich 1
Cookie 1 2
Snack
Pretzels 2 4
Orange juice 1/2 cup 1/2 cup
Dinner
Rice 3 Tbsp 3/4 cup
Chicken 1 drumstick 2 drumsticks
Broccoli 1 floret 3 florets
Milk, 2% 1/2 cup 3/4 cup
Ice cream 1/2 cup 3/4 cup
FIGURE 13.5
This version of the Food Guide Pyramid is designed to be appealing for children 2 to 6 years of age. (USDA, 1999)
449
450 Chapter 13 Nutrition from 2 to 102
Do you eat breakfast? If not, you probably should. It feeds vitamin B12, pantothenic acid, and iron. When 1/2 cup of
your body and fuels your brain. When you haven’t eaten reduced-fat milk is added to the cereal, it also provides 15%
since the night before, your brain and other tissues have to of the Daily Value for calcium. Children who eat ready-to-
rely on nutrients released from your body stores. But after eat cereals, sugared or not, have a higher overall intake of
you’ve eaten breakfast, you have a ready supply of glucose vitamins and minerals than children who do not eat cereal.3
and other nutrients to get you going. Research studies have Children who cannot or will not eat breakfast before
found that those who eat breakfast perform better on they leave the house can take a snack to be eaten on the
achievement tests and have fewer behavior problems in way to school or during recess. Fruit, yogurt, a bag of dry
school.1 Breakfast eaters are also more likely to meet their cereal, or half a sandwich is certainly a better alternative
nutritional needs than breakfast skippers.2 Many children than no breakfast at all. Having breakfast at school is also
and teens are not particularly hungry first thing in the an option. The National School Breakfast Program is
morning and will gladly go off with an empty stomach. available in about half the nation’s schools and serves more
Whether the child is in preschool or high school, this may than 7 million children. For families who meet income
be detrimental to both school performance and total guidelines the meals are free or offered at a reduced cost.
nutrient intake.3 Children participating in the National School Breakfast
So, what should you have for breakfast? A good Program have higher achievement test scores than eligible
breakfast should provide a quarter to a third of the day’s nonparticipants.1 The breakfasts served must provide at
nutrient needs. For example, a bowl of oatmeal with milk least 25% of the 1989 RDA for certain nutrients and furnish
and raisins, and a glass of orange juice provides about 300 at least 1 serving of milk; 1 serving of fruit, juice, or
Calories as well as B vitamins; vitamins C, A, and D; and vegetables; and either 2 servings of bread, 2 servings of
calcium and iron. Though not every child will eat this good meat, or 1 serving of each. This is probably a good guideline
breakfast, even children who do not like breakfast may be for the breakfast you serve at home as well.
willing to consume a slice of toast with peanut butter or a
bowl of interestingly shaped colored cereal. Although a References
1. Kennedy, E., and David, C. USDA School Breakfast Program. Am. J. Clin. Nutr.
bowl of oatmeal is preferable to a breakfast of Cookie Crisp, 67:798S–803S, 1998.
even the most sugary cereal has some redeeming features. 2. Nahikian-Nelms, M. Influential factors of caregivers’ behaviors at mealtime:
For example, while 40% of the energy in Cap’n Crunch is A study of 24 child care providers. J. Am. Diet. Assoc. 97:505–509, 1997.
3. Nicklas, T. A., O’Neil, C. E., and Berenson, G. S. Nutrient contribution of
from simple sugars, it provides 20% or more of the Daily breakfast, secular trends, and the role of ready-to-eat cereals: A review of the
Value for thiamin, riboflavin, niacin, vitamin B6, folate, data from the Bogalusa Heart Study. Am. J. Clin. Nutr. 67:757S–763S, 1998.
to soups and casseroles; fruit can be served on cereals or in milkshakes; cheese can be
included in recipes such as macaroni and cheese and pizza; milk can be added to hot
cereal, cream soups, and puddings; powdered milk can be used in baking; and meats
can be added to spaghetti sauce, stews, casseroles, burritos, and pizza.
Children often have periods known as food jags, when they will eat only certain
foods and nothing else. For example, a child may refuse to eat anything other than
peanut butter and jelly sandwiches for breakfast, lunch, and dinner. The general
guideline is to continue to offer other foods along with those the child is focused on.
What children will not touch at one meal, they may eat the next day or the next week.
Children have different nutrient needs than adults. absence of percent Daily Values for total fat, saturated fat,
Therefore, the labels on foods designed for young children cholesterol, total carbohydrate, fiber, and sodium.1 Daily
must follow different rules. The most obvious difference Values for these nutrients have not been established for
relates to how fat is listed in the Nutrition Facts section. children under 4; for this age group, the FDA has set Daily
Labels for foods intended for children under 2 years of age Values only for vitamins, minerals, and protein. Labels
are not permitted to list the amount of saturated fat, include the percent Daily Values for these nutrients when
polyunsaturated fat, monounsaturated fat, cholesterol, they are present in significant amounts.
Calories from fat, and Calories from saturated fat on the A few nutrient and health claims are allowed on young
label.1 These labels are also not allowed to carry most of children’s foods. These include claims that describe the
the claims about a food’s nutrient content or health effects. percentage of vitamins or minerals in a food as they apply
This is because dietary fat is needed for brain development to the Daily Values for children under age 2, such as
and as an energy source during the rapid growth and “provides 50% of the Daily Value for vitamin C.” Also, for
development that occurs in infancy and early childhood. children under 2, the terms “unsweetened” and “unsalted”
Eliminating this information from the label may prevent are allowed. “No sugar added” and “sugar free” are
caregivers from restricting fats in the diets of young children. approved only for use on dietary supplements for children.
As children develop, the amount of fat in the diet can The labels of foods intended for young children provide
safely be reduced. Therefore, labels on foods designed for information needed to make wise food selections, but many
2- to 4-year-olds must include information on the amount of of the foods consumed by young children do not have special
cholesterol and saturated fat per serving and can voluntarily labels because they are also adult foods. When selecting
provide information on the number of Calories from fat these foods, keep in mind that the needs of young children,
and saturated fat and the amount of polyunsaturated and especially for fat, are different than the needs of adults.
monounsaturated fat per serving. The serving sizes listed
are based on servings appropriate for small children.
Reference
Another difference between standard food labels and 1. Kurtzweil, P. Labeling rules for young children’s foods. FDA Consumer 29:14–18,
those for foods designed for children under age 4 is the March 1995.
Nutrition Facts
Serving Size 1/4 cup (15g)
Servings Per Container About 30
Childre
n
Fiber 1g Saturated Fat 0g
Protein Infants 1-4 N
ut
0-1
6%
Sugars Cholesterol 0mg
Se
rv
rit
in
0g A g
Value 7% % m io Siz
% Daily
Ca oun nF e1
0 lo t Pe jar
0% % rie r Se ac (140
Protein 0 s ts g)
Sodium 10mg
rv
To 110 ing
A 0% %
Vitamin
ta
10 Ch S l Fa
Protein
at
15% 0% So ole urat t Calor
2g
C
Vitamin 6 diu ste ed Fa ies
from
45% 8% To m ro t Fat
Calcium ta l
Total Carbohydrate
0
Iron
15 % 0 %
45% 0%
3 27g lC
arb
Die oh
P S tary ydra
0g
0g
mVita in E 3
ro u
te gar Fibe te 0mg
45% 0% in s r
Thiamin
% 10mg
Ribofla
vin 25% 0%
15 %
2
1 Infants Children Dietary Fiber 4g P Da
ro il
V tein y V
it
Ir am 0% ue
al
27g
4g
Niacin
on in
Sugars 18g •
•
Vitam
Calciu in A 6%
0g
m 2%
Protein 7% 6% Protein 0g
Vitamin A 0% 0%
% Daily Value
Vitamin C 0% 0%
Protein 0% • Vitamin A 6%
Nutrition label for foods for Calcium 15% 10% Vitamin C 45% • Calcium 2%
children under age two Iron 45% 60% Iron 2%
Vitamin E 15% 8%
Thiamin 45% 30% Nutrition label for foods for children
Riboflavin 45% 30% ages two to four
Niacin 25% 20%
Phosphorus 15% 10%
Nourishing Young Children Can Be a Challenge 453
BMI BMI
97th
34 34
Body mass index-for-age percentiles: Over-
32 Girls, 2 to 20 years weight 95th 32
30 30
At risk
90th
28 28
85th
26 26
75th
24 24
Normal
22 50th 22
20 25th 20
18
10th
5th
FIGURE 13.6
18
3rd
Growth charts are helpful for monitoring
16 16 a child’s pattern of growth. This example
Under-
weight illustrates BMI-for-age percentiles for
14 14 girls ages 2 through 20. BMI can be used
beginning at 2 years of age, when height
can be measured accurately. BMI is
12 12
predictive of body fat and has been
kg/m2 kg/m2 recommended to screen for underweight
and overweight children, ages 2 years
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
and older. The colored areas represent
Age (years)
BMI values that are associated with
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the Nation Center for Chronic Disease Prevention and Health Promotion (2000).
CDC
CENTER FOR DISEASE CONTROL
AND PREVENTION
underweight, normal weight, at-risk
of overweight, and overweight.
454 Chapter 13 Nutrition from 2 to 102
determine the cause of his or her low body weight (see Figure 13.6). Nutritional inter-
ventions such as offering children small, frequent, nutritious meals and snacks can in-
crease energy intake and help increase body weight. Underweight adolescents can
increase their weight by combining muscle-building exercises with increases in energy
intake.
FIGURE 13.8
Children should enjoy participating in a variety of activities of varying intensity.
FIGURE 13.9
Frequent tooth brushing can help prevent cavities in
children. (David Young-Wolff/PhotoEdit)
permanent ones. Children’s teeth should be brushed as soon as they erupt, and those 3
years of age and over should be examined by a dentist regularly.
100
80
Percent of 60
children aged
1–5 years
with blood 40
lead ≥ 10µg/dL
20
FIGURE 13.10
The prevalence of children ages 1 to 5 with elevated blood lead levels has
1976–1980 1988–1991 1991–1994 1999–2000 decreased dramatically over the last 25 years due to interventions such as
Years Surveyed the elimination of lead from paint, gasoline, and solder. Source: NHANES.
functioning of the nervous system. Higher levels of lead can contribute to iron defi-
ciency anemia, changes in kidney function, nervous system damage, and even seizures,
coma, and death. In young children, lead poisoning can cause learning disabilities and
behavior problems.19 In adults, lead poisoning can damage the reproductive organs
and cause high blood pressure.20 During pregnancy, lead toxicity can damage the fetal
nervous system.
Lead is found naturally in the earth’s crust, but over the years industrial activities
have redistributed it in the environment. Lead is now found in soil contaminated with
lead paint dust; it also enters drinking water from old corroded lead plumbing, lead
solder on copper pipes, or brass faucets. It is found in polluted air, in leaded glass, and
in glazes used on imported and antique pottery. These can contaminate food and bev-
erages. Because of the risks of lead toxicity from environmental contamination, lead is
no longer used in house paint, gasoline, or solder. As a result, the number of children
with elevated blood lead levels has decreased dramatically (Figure 13.10).21 The U.S.
Department of Health and Human Services has established a national goal of elimi-
nating blood lead levels greater than 10 g per dL in children younger than 6 years of
age by 2010.19 Despite these gains, there are still nearly a million children under 6
years of age who have blood lead levels that are high enough to cause damage. For a
number of reasons, the problem is greatest among children living in poverty. Their ex-
posure is likely to be greater because they tend to live in older buildings where
chipped paint and old plumbing may be contaminated with lead. In addition, chil-
dren living in poverty are more likely to be malnourished, and malnutrition increases
lead absorption because lead is better absorbed from an empty stomach and when
other minerals such as calcium, zinc, and iron are deficient.
Children should have their blood lead levels tested.19 The effects of lead poisoning
are permanent, but if high levels are detected early, the lead can be removed with med-
ical treatment, preventing damage (Table 13.2).
TABLE 13.2
What You Can Do to Reduce Lead Exposure
Reducing exposure from lead paint: If you live in a house built before 1978, it
may contain lead paint or lead paint may have been sanded or scraped off at
some time.
• Wash floors and other surfaces weekly with warm water and detergent.
• Wipe soil off shoes before entering the house.
• Cover exposed soil in the yard with grass or mulch.
Reducing exposure from tap water: If your home has old plumbing, lead may be
leaching into your tap water. More lead leaches into hot water than cold, and
water that has been standing in the pipes has more lead.
• Use cold water for drinking and cooking.
• Allow water to run for 30 seconds before use.
Reducing exposure from food containers: Pottery glazes and lead crystal contain
lead. The FDA limits the amount of lead allowed in ceramic foodware, but the
lead content of pottery designed for ornamental use is not regulated.
• Look for engraved warnings such as “Not for Food Use—May Poison Food”
and “For Decorative Purposes Only” to identify pottery that should not be
used to serve food.
• Do not store acidic foods such as fruit juices or tomato juice in ceramic
containers.
• Limit the use of antique or collectible housewares for food or beverages to
special occasions.
• Use your lead crystal stemware to drink from, but do not store beverages in
lead crystal.
• Pregnant women should not routinely use lead crystal glasses.
• Infants should not be fed from lead crystal baby bottles.
For additional information: Go to the Centers for Disease Control and Prevention
at www.cdc.gov/health/lead.htm or the Environmental Protection Agency’s
National Lead Information Center at www.epa.gov/lead/nlic.htm
Perhaps the most important nutritional influence of television is that it reduces ac-
tivity. Hours spent watching television are hours when physical activity is at a mini-
mum. One study showed that children who watch 4 or more hours of TV per day had
more body fat and a greater BMI than those who watch fewer than 2 hours a day.23 In
addition to television, children and adolescents today replace time spent at more phys-
ically demanding activities with time spent playing computer and video games.
Fats, Oils,
Milk, Cheese, & Sweets
Meat, Poultry, Fish,
& Yogurt Dry Beans, Eggs,
& Nuts
Bread, Cereal, Rice,
& Pasta
100
80
(percent)
Acne is a common problem during 40
adolescence.At one time it was
believed to be related to diet, and
long lists of foods to avoid were
doled out to teens with acne.We now
20 FAT
know that heredity and changes in
hormone levels play a major role in
the development of acne, and that FAT
anxiety, lack of sleep, and hormonal
fluctuations are more likely to cause 0
15-year-old 15-year-old
acne flare-ups than specific foods. boy girl
Despite the fact that specific foods FIGURE 13.12
do not cause acne, a well-balanced
diet is important for ensuring that After puberty, males have a higher percentage of lean body mass and less body fat than females. (Adapted from
the skin has all the nutrients needed Forbes, G. B. Body composition. In Present Knowledge in Nutrition, 6th ed. Brown, M. L. ed. Washington, DC:
to maintain its integrity. International Life Sciences Institute-Nutrition Foundation, 1990)
they need. Additional amounts of vitamins A, C, and E are needed to preserve the
structure and function of the newly synthesized cells. Adequate amounts of these are
generally consumed by teens.26
lacking in the American diet: french fries, which are high in fat and salt, are the most
frequently consumed vegetable. And many people never consume fruit. Sources of
fruits and vegetables acceptable to teens include fruit juice, salads, and tomato sauce
and vegetables on pizza and spaghetti.
Fast food and sugared cereal Since the teen diet, especially that of teenage boys, is typically high in fat, saturated
can be part of a healthy diet fat, cholesterol, and sodium, meals offered at home should be low in fat and sodium.
Teens are no longer fed by their parents, but healthy choices, such as reduced-fat milk
as long as these choices are and dairy products, vegetables, and fruits, should be available at home.
consumed in moderation and
balanced with a variety of
nutritious choices. Fast food needs to be balanced with healthier choices
Children and teens generally love fast food, and there is nothing wrong with an occa-
sional fast-food meal (Figure 13.14). But a steady diet of burgers, fries, and tacos will
likely contribute to an overall diet that is high in calories, fat, and salt and low in cal-
cium, fiber, and vitamins A and C. The few pieces of shredded lettuce and chopped
tomatoes that garnish your burger or taco are not enough to meet the serving recom-
mendations for vegetables. Typical fast food meals are also lacking in milk and fruits. To
fit fast food into a healthy diet, more nutrient-dense, fast-food choices can be made and
other meals and snacks throughout the day need to supply the missing nutrients. Many
fast-food franchises now offer fruits, salads, and milk. And some of the old standbys are
not bad choices. A plain, single-patty hamburger provides a lot less fat and energy than
one with two patties and a high-fat sauce. A chicken sandwich can be a healthy choice if
FIGURE 13.14 it is grilled or barbecued, not breaded and fried (see Nutrient Composition of Foods
booklet). French fries are high in fat and calories, but can be part of a healthy diet if con-
Eating fast food doesn’t necessarily make sumed in moderation. A fast-food meal is only one part of the total diet. If the missing
your overall diet unhealthy.(Chris Hackett/ milk, fruits, and vegetables are consumed at other times during the day, the total diet
Photographer’s Choice/Getty Images) can still be a healthy one.
with anabolic steroids, androstenedione, and creatine (see Chapter 11). Anabolic
steroids are illegal, and although they do increase muscle mass, the risks far outweigh
the benefits. Androstenedione is a testosterone precursor that the FDA has asked sup-
plement manufacturers to remove from their products due to concerns about safety.
Creatine improves exercise performance in sports requiring short bursts of activity and
has not been associated with serious side effects.29 Nonetheless, the best and safest way
for young athletes to increase muscle mass is the hard way—lifting weights and eating
more.
Success in some sports depends on being light and lean. Athletes involved in sports
such as gymnastics and wrestling may restrict their food intake in order to keep their
weight low. Weight restriction, however, may affect nutritional status and maturation
and increase the risk of developing an eating disorder.30 In female athletes, the combi-
nation of hard training and weight restriction can lead to a syndrome referred to as the
female athlete triad, which includes disordered eating, amenorrhea, and osteoporosis
(see Chapter 11). In male athletes who participate in sports such as wrestling that re-
quire athletes to fit into a specific weight class on the day of the event, dangerous
methods of quick weight loss are a concern. Severe energy intake restriction, water de-
privation, self-induced vomiting, and diuretic and laxative abuse are common prac-
tices among wrestlers. Low-calorie diets can interfere with normal growth and may be
too limited in variety to meet these athletes’ needs for vitamins and minerals. Restrict-
ing water intake and encouraging sweat loss to decrease body weight may be even
more dangerous. These practices allow the temporary weight loss necessary to put the
athlete in a lower weight class, but the resulting dehydration is dangerous and can im-
pair athletic performance.31 Fluids should be consumed before, during, and after exer-
cise to prevent dehydration.
with more cells and more cell function than we need. As a person ages the loss of cells
begins to have an impact on how well the body operates. As functional capacity de-
clines the effects of aging become evident in all body systems. The body also loses its
ability to repair damage so older people may die from a disease that they could have
easily recovered from when they were younger.
We don’t completely understand why cell number and function declines over time In young adults, the functional
but there are a number of hypotheses. One states that aging is programmed in our capacity of organs is four to ten
genes. This means that we each come into the world with a biological clock that is set times that required to sustain life.
to go off at a particular time, give or take a few years. When that clock goes off it sig-
nals our bodies first to age and then to die. Another hypothesis suggests that we age as
a result of the wear and tear of our lives. Exposure to toxins, illnesses, a poor diet, ex-
cessive use of alcohol, cigarette smoking, excess sun exposure, and many other physi-
cal and emotional stresses will wear things out more quickly. One of the sources of
this wear and tear is free radicals. Free radicals, generated from both normal metabolic
processes and exposure to environmental factors, cause oxidative damage to proteins,
lipids, carbohydrates, and DNA in our bodies. This damage done by free radicals is
associated with aging and has been implicated in the development of a number of
chronic diseases common among older adults, including cardiovascular disease and
cancer.
Most of us are not healthy for all of our later years How
long can people live? Human life span is about 100 to 120 years, but most people do ▲
* Life span The maximum age to which
not live that long. In the United States today, people live an average of 77.2 years.32 members of a species can live.
This average life expectancy varies between and within populations. In the United
States, it is greater in women than in men and it is higher in Caucasians than in ▲* Life expectancy The average length
African Americans. It is lower in developing countries where access to good nutrition of life for a population of individuals.
and adequate health care are limited (see Chapter 15). Due to advances in technology
and improved nutrition and health care, life expectancy in the United States has in-
creased over the years.
Environment Lifestyle
Disease Nutrition
Accidents Rate Exercise
Toxins of aging Stress
FIGURE 13.16
Genetics
Susceptibility to The rate at which individuals age is affected
environmental stress by their genetic makeup, the environment in
Ability to repair cellular
which they live, and the lifestyle choices they
damage
make.
466 Chapter 13 Nutrition from 2 to 102
80
60
Number of
persons 40 older
(millions) 65 or
20
85 or older
0
1900 1950 2000 2050
Year Projected
FIGURE 13.17
This graph illustrates the increase in the total number of persons age 65 and older and 85 and older from 1900 to
2050. Data through 2050 are based on projections of the population and indicate that in the next few decades
there will be almost 80 million people in the United States who are 65 or older. (U.S. Census Bureau. Decennial
Census Data and Population Projections. Available online at www.agingstats.gov)
Even though average life expectancy in the United States is over 77 years, the aver-
age healthy life span is only about 69 years.33 This means that on average the last 8
years of life are restricted by disease and disability. The goal of successful aging is to in-
crease not only life expectancy but the number of years of healthy life that an individ-
ual can expect. Achieving this goal is important because we live in an aging
A person born in the United States in population. Currently about 12.4% of the U.S. population is 65 years of age or over
2000 has a life expectancy of about and this is expected to increase to about 19.6% by the year 2030 (Figure 13.17).34
77 years. For someone born in 1900, The fastest-growing segment of the population in industrialized nations is individuals
life expectancy was 49 years. over the age of 85, called the oldest old.35 Individuals in this age group tend to have
more activity limitations, experience more chronic conditions, and require more ser-
vices than younger adults. This oldest old population accounts for a large part of the
public health budget. Keeping older adults healthy will benefit not only the aging in-
dividuals themselves but also the family members who must find the time and resources
to care for them and the public health programs that attempt to meet their needs.
Vitamin A
Vitamin D† 100%
Vitamin E
Vitamin K Men
Vitamin C Women
Thiamin
Riboflavin
Niacin
Vitamin B6
Folate FIGURE 13.18
Vitamin B12
The nutrient needs of older adults are not
Calcium drastically different from those of young
Magnesium adults. This graph illustrates the percentage
increase in micronutrient recommendations
Iron
for adults age 51 and older compared to
Iodine those of young adults ages 19 through 30.
Zinc The RDA for vitamin B12 is not increased,
0 10 20 30 40 50 but it is recommended that vitamin B12 be
Percent increase obtained from fortified foods or supplements.
†This represents the AI for individuals 51 to 70 years old. For those over age 70 the AI is The RDA for iron for women over 50 years
increased by 200% of age is reduced by 50%.
50
Body Body
fat Body fat Body
fat fat
40
Percent of body weight
30
Muscle
Muscle
20
Muscle
Muscle
10
FIGURE 13.19
0 In most individuals, the proportion of muscle mass decreases and body fat increases
20 – 29 40 – 49 60 – 69 70 – 79 with age. (Adapted from Cohen, S. H., et al. Compartmental body composition based
Age group (years) on the body nitrogen, potassium, and calcium. Am. J. Physiol. 239:192–200, 1980)
468 Chapter 13 Nutrition from 2 to 102
older adults who are overweight, the risks associated with excess body fat are lower
than they are for younger adults.36 Stable body weight is a sign of good health. Weight
loss may reduce the ability to ward off disease or be a symptom of disease. Extreme
thinness or unintentional weight loss is a health risk, especially among older adults.
Although laboratory studies in animals have found that a diet deficient in energy can
Research on monkeys, rodents, slow aging and extend life span, this effect has not been demonstrated in humans.37
fish, and even fruit flies has
demonstrated that cutting calorie Recommendations for protein, carbohydrate and fat do
intake below normal increases not change with age Unlike calorie needs, the need for protein does not
longevity. The calorie-deprived decline with age. Therefore, an adequate diet for older adults must be somewhat
animals are also healthier, with higher in protein relative to calorie intake in order to meet needs.
more youthful hormone levels, The proportion of carbohydrate recommended in the adult diet also remains the
better immune function, and fewer same in older adults, but nutrient density becomes more important. Most dietary car-
chronic diseases. We don’t know bohydrates should be from less refined sources in order to ensure adequate vitamin
yet whether the same is true for and mineral intake despite a reduction in calorie needs. In addition, whole grains are
humans, but a national research higher in fiber. Fiber, when consumed with adequate fluid, helps prevent constipation,
project funded by the National hemorrhoids, and diverticulosis—conditions that are common in older adults. High-
Institute on Aging is currently fiber diets may also be beneficial in the prevention and management of diabetes, car-
underway to see if eating less can diovascular disease, and obesity.
also slow down aging in people. The digestion and absorption of fat does not change as adults age; therefore the
recommendations regarding dietary fat apply to older as well as younger adults. A diet
with 20 to 35% of energy from fat that contains adequate amounts of the essential
fatty acids and limits saturated fat, trans fat, and cholesterol is recommended. Follow-
ing these recommendations will allow older adults to meet their nutrient needs with-
out exceeding their energy requirements and may delay the onset of chronic disease.
However, there are certain situations, such as being underweight, where greater fat in-
take may be warranted.
decreases and the risk of bone fractures increases. The loss of calcium from bone is ac-
celerated in women due to the normal hormonal changes of menopause. During ▲* Menopause Physiological changes
menopause, which normally occurs around the age of 50, the cyclical release of the fe- that mark the end of a woman’s capacity
male hormones estrogen and progesterone slows and eventually stops, causing ovula- to bear children.
tion and menstruation to cease. The decrease in estrogen is accompanied by changes
in mood, skin, and body composition, with body fat increasing and lean tissue de-
creasing. Reduced estrogen also increases the risk of osteoporosis by increasing the rate
of bone breakdown and decreasing calcium absorption from the intestine. As a result
of age-related bone loss the AI for adults over age 51 is 1200 mg, 200 mg greater than
the AI set for younger adults. Although the decrease in estrogen that occurs at
menopause causes bone loss, it cannot be prevented by increasing calcium intake
alone, so the recommended intakes for men and women are not different.
FIGURE 13.22
With age total muscle mass declines, leading to a loss of strength. These
magnetic resonance images of thigh cross-sections from a 25-year-old man
(left) and a 65-year-old man (right) illustrate that the older man has a
greater amount of fat (shown in white) around and through the muscle,
indicating significant muscle loss. (Courtesy S. A. Jubias and K. E. Conley,
University of Washington Medical Center)
Good Nutrition Can Keep Adults Healthy 471
TABLE 13.3
Aging Can Affect Nutrition
tasks of day-to-day life more difficult. The changes in muscle strength contribute not
only to physical frailty, which is characterized by general weakness, impaired mobility
and balance, and poor endurance, but also to the risk of falls and fractures. In the old-
est old, loss of muscle strength becomes the limiting factor determining whether they
can continue to live independently. The changes that occur with
Some of the reduction in muscle strength and mass is due to changes in hormone aging including an increase in
levels and in muscle protein synthesis, but a lack of exercise is also an important con- the prevalence of disease and
tributor.42 Regular exercise can help maintain muscle mass, bone strength, and car- the likelihood of social and
diorespiratory function and can increase energy needs. Exercise can reduce the loss of economic changes, increase
lean body mass, maintain fitness and independence, and allow an increase in food the risk of malnutrition.
472 Chapter 13 Nutrition from 2 to 102
intake without weight gain so micronutrient needs are more easily met. Therefore,
maintaining regular physical activity remains important throughout life.
TABLE 13.4
Medications May Cause Nutritional Deficiencies
with the properties of aspirin that help prevent heart disease. Individuals taking any
medication should consult their doctor, pharmacist, or dietitian regarding how the
drug could affect the action of other drugs they may be taking, how the drug could af-
fect their nutrition, and how their nutrition could affect the action of the drug.
MALNUTRITION
Increased use
of medications
Increased Decreased
illness accessibility
of food
FIGURE 13.24
The causes and consequences of malnutrition in the elderly are linked.
Good Nutrition Can Keep Adults Healthy 475
TABLE 13.5
DETERMINE: A Checklist of the Warning Signs of Malnutrition
as well as relatives, friends, and others caring for the elderly in evaluating the nutritional
status of the aging population. This program developed the DETERMINE checklist,
which is based on an acronym for the physiological, medical, and socio-economic situa-
tions that increase the risk of malnutrition among the elderly (Table 13.5). The elderly
themselves, family members, and caregivers can use this tool to identify when malnutri-
tion is a potential problem.
Calcium, Vitamin D,
Vitamin B12
Supplements
f+
f+ f+
Vegetable
Fruit Group
Group
2 or more Servings
3 or more
Servings f+ f+
f+ f+ f+
Bread, Fortified
Cereal, Rice, &
Pasta Group
6 or more Servings
f+ f+ f+
f+
Water
8 or more Servings
FIGURE 13.25
H2O H2O H2O H2O H2O H2O H2O H2O
This modification of the Food Guide Pyramid
targets the needs of healthy mobile seniors fat (naturally occurring and added)
(over age 70) and is not designed to meet the sugars (added)
needs of those with special dietary needs or f+ fiber (should be present)
significant health problems. These symbols show fat, added sugars, and fiber in foods.
reduced among the elderly.47 The recommended numbers of servings are equal to or
greater than the minimums recommended by the Food Guide Pyramid, and nutrient-
dense choices from each food group are recommended. To highlight the importance
of fiber in the diets of older adults, the pyramid for seniors includes a fiber icon in the
food groups containing high-fiber foods such as grains, fruits, vegetables, and beans,
nuts, and seeds. Another key difference in this pyramid is a flag at the top that indi-
cates the possible need for dietary supplements.
PIECE IT TOGETHER
▼
Eight of the items on the DETERMINE checklist apply to
Anna’s grandmother, confirming her concerns about the risk Your answer:
of malnutrition. Anna takes Shirley to a dietitian who asks
her to recall the diet she ate before her teeth were extracted.
W HATOTHER FACTORS NEED TO BE CONSIDERED
Shirley’s Original Diet WHEN RECOMMENDING A DIET FOR S HIRLEY ?
Food Amount ▼
Breakfast Shirley needs a diet that includes foods that are not only
Bran flakes 3/4 cup easy to prepare and carry home on the bus but that are also
Low-fat milk 1 cup easy to chew. To ensure her grandmother has the foods she
Coffee 1 cup needs to stay healthy Anna decides to take Shirley shopping
Low-fat milk 1 Tbsp once a month for the heavy, bulky items like paper goods,
Sugar 2 tsp laundry soap, rice, cereal, and canned foods. Shirley can
Lunch handle the smaller, more perishable items when she takes
Chicken soup 1 cup the bus to the store.
Crackers 6 pieces
Apple 1 small
478 Chapter 13 Nutrition from 2 to 102
TABLE 13.6
Can a Supplement Help?
can provide a meal with almost no preparation. Medical nutritional products such as
Ensure or Boost, can also be used to supplement intake. These canned, fortified prod-
ucts have a long shelf life and can meet nutrient needs with a small volume.
Nutrition programs can help maintain nutritional health For information about
in the elderly The Federal Older Americans Act provides nutrition services to healthy aging and
older individuals who are in economic need, particularly low-income minorities. Pro- resources for elderly
grams that provide nutritious meals in communal settings promote social interaction persons and their
and can improve nutrient intake. The Congregate and Home-Delivered Nutrition families, go to the
Programs established by the Older Americans Act provide congregate meals at loca- Administration on Aging at
tions such as senior centers, community centers, schools, and churches. For those who www.aoa.dhhs.gov/, the National Institute
are unable to attend congregate meals, home-delivered meals are available. on Aging at www.nih.gov/nia/, or visit the
Although such programs are a first step in meeting nutritional needs, currently Meals on Wheels Association of America at
most provide only one meal a day for five days a week. Each meal served must provide www.projectmeal.org/
at least a third of the 1989 RDA. Oftentimes however, because seniors don’t have the
resources or ability to prepare other meals, these delivered meals end up providing al-
most half of their total intake for the day.49 Studies have shown that individuals who
receive these meals have a better-quality diet and fewer hospitalizations than those
who do not.50 These and other programs addressing the nutritional needs of older
adults are described in Table 13.7.
Assisted living has benefits and risks For many, the physical and
psychological decline associated with aging eventually causes them to require assis-
tance in living. Without help, many older adults may be unable to get to markets and
food programs, restricting the types of food available to them. While a social support
system consisting of family members, friends, and other caregivers can help many
people stay at home, others may require assisted-living facilities, where they have their
own apartments but can obtain assistance around the clock. For some, however, the
degenerative changes of disease and aging require a nursing home to provide the ap-
propriate care.
480 Chapter 13 Nutrition from 2 to 102
TABLE 13.7
What Federal Programs Help Older Americans?
Older Americans Act—Title III Congregate and Home-Delivered
Nutrition Programs
Serves at least one meal five days a week to persons 60 years and older. Meals
are served at home or in churches, schools, senior centers, or other facilities.
Older Americans Act—Title VI Congregate and Home-Delivered
Nutrition Programs
Provides home-delivered and congregate meals to Native American
organizations.
Older Americans Act—Title III Health Promotion and Disease
Prevention Program
Provides health-promotion and disease-prevention services in areas where there
are large numbers of economically needy older adults.
Nutrition Screening Initiative
Promotes nutritional screening and more attention to nutrition in all health-care
and social-service settings that provide for older adults.
Food Stamp Program
Provides food stamps to low-income individuals including the elderly. These can
be used instead of cash to purchase food.
Nutrition Program for the Elderly
Provides grants, cash, and commodity foods to states and tribes to supplement
congregate and home-delivered meal programs.
Commodity Supplemental Food Program—Elderly
Provides food, nutrition education, and health-service referrals to individuals
with low incomes, including the elderly.
Child and Adult Care Food Program (Adult Day Care)
Provides cash reimbursements and food commodities to community day-care
centers that serve meals and snacks to children and elderly with special needs.
Food Distribution Program on Indian Reservations
Distributes commodity foods to low-income persons, including the elderly, living
on or near Indian reservations.
Those in nursing homes are at increased risk for malnutrition because they are
more likely to have medical conditions that increase nutrient needs or that interfere
with food intake or nutrient absorption, and because they are dependent on others to
provide for their care. In addition, 50% of institutionalized elderly suffer from some
form of disorientation or confusion, which further increases the likelihood of de-
creased nutrient intake. Even when adequate meals are provided, nursing-home resi-
dents frequently do not consume all of the food served, increasing the likelihood of
fluid and energy deficits.51
(a) (b)
FIGURE 13.26
Chronic alcohol consumption can cause permanent liver damage. A normal liver is shown on the left (a), and a
cirrhotic liver is shown on the right (b). (a: Custom Medical Stock Photo, Inc. b: Science Herita/Custom Medical
Stock Photo)
obesity. Calories consumed as alcohol are more likely to be deposited as fat in the ab-
dominal region; excess abdominal fat increases the risk of high blood pressure, heart
disease, and diabetes. There is also some evidence suggesting that alcohol consump-
tion may increase the risk of breast and colon cancer; the effects depend on the
amount consumed.54
The most significant physiological effects of chronic alcohol consumption occur in
the liver. Alcoholic liver disease progresses in three phases. The first phase is fatty liver,
a condition that occurs when alcohol consumption increases the synthesis and deposi-
▲* Alcoholic hepatitis Inflammation of tion of fat in the liver. The second phase, alcoholic hepatitis, is an inflammation of the
the liver caused by alcohol consumption. liver. Both of these conditions are reversible if alcohol consumption is stopped and
good nutritional and health practices are followed. If alcohol consumption continues,
▲* Cirrhosis Chronic liver disease cirrhosis may develop. This is an irreversible condition in which fibrous deposits scar
characterized by the loss of functioning the liver and interfere with its function. Since the liver is the primary site of many
liver cells and the accumulation of fibrous metabolic reactions, cirrhosis is often fatal (Figure 13.26). In addition to causing liver
connective tissue. disease, heavy drinking is associated with hypertension, heart disease, and stroke.
should not consume alcohol because it can damage the fetus. Children and adoles-
cents should not consume alcohol because they are more likely to suffer its toxic ef-
fects—drunkenness and poisoning leading to seizures, coma, and death. Individuals
who plan to drive or operate machinery should not consume alcohol because it can
impair coordination and reflexes. Alcoholics should avoid alcohol because they cannot
restrict their drinking to moderate levels. Finally, individuals taking medications that
can interact with alcohol should avoid alcohol.
Individuals who do drink should not drink in excess (Figure 13.27). When alco-
hol is consumed, it should be consumed slowly with meals, which slows absorp-
tion. It usually takes an hour to metabolize the alcohol in one drink (0.5 ounces
distilled liquor, 12 ounces beer, or 5 ounces wine), so no more than one drink If you drink alcoholic
should be consumed every 1.5 hours. Sipping, not gulping, gives the liver time to beverages, do so in moderation
break down what has already been consumed. Unfortunately, once alcohol is in the
body, the rate at which it is metabolized and eliminated cannot be accelerated. FIGURE 13.27
Cold showers, brisk walks, and black coffee may wake you up, but they will not
sober you up. The Dietary Guidelines for Americans
recommends that alcohol be consumed in
moderation. (USDA, DHHS, 2000)
1. Do these height and weight measurements recorded for a b. What is the percent of calories from carbohydrate and
girl from age 6 to age 9 indicate any problems? fat in the meal?
c. Compare the amount of calories, fat, protein, iron,
Age Height (in.) Weight (lb)
calcium, and vitamin A to the recommended intake
6 45 44
for someone of your age, weight, and lifestage.
7 48 53
8 50 77 4. How does age affect energy needs?
9 52 97 a. How does your average energy intake from the food
record you kept in Chapter 2 compare to the EER for
a. Calculate her BMI and plot the values on a BMI-for-
a person who is your height, weight, and activity level
age growth chart (growth charts are in Appendix B).
but is 75 years old?
b. What recommendations would you have about her
b. Modify your food choices for one day to meet the
weight?
recommendations of the senior Pyramid shown in
2. What food groups are included in a fast-food lunch? Figure 13.25 while not exceeding what your energy
a. How many servings from each food group of the Food needs would be at age 75.
Guide Pyramid do a Big Mac, fries, and a 16-ounce
5. How do medical conditions and dietary restrictions affect
cola represent?
food choices?
b. If you ate this fast-food meal for lunch, how many
a. How might you modify your food choices to
additional servings from each food group would you
accommodate a low-sodium diet?
need to satisfy the daily recommendations of the Food
b. How might you modify your food choices to
Guide Pyramid?
accommodate a restriction of protein to 0.6 gram
c. Select foods from each group to complete your intake
per kilogram of body weight?
for the day.
c. How might you modify your food choices to
d. Do the foods you selected meet the selection
accommodate a loss of smell and taste?
recommendations of the Food Guide Pyramid
d. How might you modify your food choices to
(Table 2.1) and your energy needs?
accommodate a dry mouth and poorly fitting
3. What’s in your favorite fast-food meal? dentures?
a. Use the Internet or a diet analysis computer program
to look up the nutrient composition of your favorite
fast-food meal.
484 Chapter 13 Nutrition from 2 to 102
SUMMARY
1. Good nutrition in childhood sets the stage for Eating disorders are more common in adolescence than
nutrition and health in the adult years. Diets high at any other time. Adolescent athletes are susceptible to
in energy, saturated fat, cholesterol, sugar, and salt nutrition misinformation, and they may try dangerous
promote the development of obesity, diabetes, high practices such as using anabolic steroids to increase
blood cholesterol, and high blood pressure even muscle mass or fad diets and fluid restriction to lose
in children, and these conditions follow them weight.
into adulthood. Healthy eating habits learned in
childhood can reduce the risk of chronic disease 8. Aging is the accumulation of changes over time that
later in life. results in an ever-increasing susceptibility to disease and
death. A combination of genetic, environmental, and
2. Total energy and nutrient needs increase as children lifestyle factors determines how long people live and
grow because of the increase in total body weight and how long they remain healthy. As a population, we are
activity level. The proportion of fat needed in the diets living longer but not necessarily healthier lives. Good
of young children is much lower than in infancy but nutrition is important for increasing the number of
still somewhat higher than in adults. Carbohydrates healthy years.
should come primarily from whole grains, vegetables,
fruits, and milk. Iron deficiency remains a problem 9. The physiological changes that occur with age affect
among children and inadequate calcium intake the ability to acquire, consume, digest, absorb, and
contributes to low peak bone mass. metabolize nutrients. Energy needs are reduced so a
nutrient-dense diet is needed to meet needs. Fluid
3. A varied diet can meet children’s nutrient needs needs are not different but the risk of dehydration is
without dietary supplements, but skipped meals, food increased. Vitamin B12 requirements are the same but
jags, and erratic eating habits can make meeting needs the vitamin should come from fortified foods or
a challenge. In children as well as infants and teens, supplements in order to ensure adequate absorption.
growth that follows standard patterns indicates The requirements for calcium and vitamin D are
adequate nutrition. increased and it may be hard for older adults to get
enough of either from diet alone.
4. High-sugar diets can contribute to tooth decay but
there is no evidence they cause hyperactivity. Exposure
to lead affects brain development. Television contributes 10. Both physical limitations and chronic diseases affect
to inactivity and poor food choices in children. nutrient requirements and the ability to consume a
nutritious diet. The medications used to treat disease
5. During adolescence, accelerated growth and sexual also affect nutritional status, especially when the
maturation have an impact on nutrient requirements. medications are taken over long periods of time and
Body composition and the nutritional requirements of when multiple medications are taken simultaneously.
boys and girls diverge. Boys gain more lean body tissue, The DETERMINE checklist helps identify older adults
while girls gain proportionately more body fat. During who are at risk for malnutrition.
the adolescent growth spurt, total energy and protein
requirements are higher than at any other time of life. 11. To meet nutrient needs the elderly must overcome
Young men require more protein and energy than economic limitations and social isolation. The federal
young women. Older Americans Act includes programs that provide
older adults with low-cost or free meals in their homes
6. In adolescence, vitamin requirements increase or in a social setting. Although these programs are
to meet the needs of rapid growth. The minerals helpful, they do not ensure adequate nutrition for all
iron, calcium, and zinc are likely to be low in the elderly people.
adolescent diet. Iron deficiency anemia is common,
especially in girls as they begin losing iron through 12. Alcohol has short-term effects on the central nervous
menstruation. Consuming too much fast food system, including impairment of reasoning, judgment,
contributes to a diet that is high in calories, fat, and coordination, and eventually the loss of
and salt and low in calcium, fiber, and vitamins A consciousness. Chronic alcohol use damages the liver
and C. Vegetarian diets can be a problem if not well and can cause malnutrition by decreasing nutrient
constructed. intake and absorption and interfering with nutrient
utilization. Some groups should never drink, but
7. Psychosocial changes occurring during the adolescent moderate alcohol consumption can have health
years make physical appearance of great concern. benefits in others.
References 485
REVIEW QUESTIONS
1. How does nutrient intake during childhood affect the 12. What is life expectancy? How does it differ from healthy
risk of chronic disease later in life? life expectancy?
2. What is the best way to determine if a child is eating 13. List three physiological changes that occur with aging.
enough? 14. Why is it so important that elderly individuals consume
3. What impact do parents’ weights have on children’s a nutrient-dense diet?
weights? 15. What social and economic factors increase nutritional
4. What factors influence the maximum height a child will risk among the elderly?
reach? 16. Why are older adults at risk of vitamin B12 deficiency?
5. How do the recommendations for fat intake change as Vitamin D deficiency?
children get older? 17. How can nutrition affect your risk of developing
6. Why is anemia a problem in young children? In teenage macular degeneration?
girls? 18. Explain why physical disabilities and mental illness
7. Why are snacks an important part of children’s diets? affect nutritional status.
8. Why is breakfast important? 19. What are the short-term effects of alcohol?
9. How can fast foods be incorporated into a healthy diet? 20. What effects does alcohol have on the liver?
10. What is the adolescent growth spurt? How does it affect 21. What are the benefits of alcohol consumption?
nutrient requirements?
11. Why are teenagers particularly susceptible to eating
disorders?
REFERENCES
1. CDC, National Center for Health Statistics. Available online at 10. Hingley, A. T. Preventing childhood poisoning. FDA Consumer
www.cdc.gov/nchs/fastats/overwt.htm/Accessed September 2, 30:7–11, March 1996.
2004. 11. U.S. Department of Agriculture. Nutrition Program Facts:
2. American Diabetes Association. Type 2 diabetes in children National School Lunch Program: Qs and As on the National
and adolescents. Diabetes Care 23:381–386, 2000. School Lunch Program. Available online at www.usda.gov/
3. National Institute of Diabetes & Digestive & Kidney Diseases, cnd/Lunch/default.htm/Accessed April 12, 2004.
National Institutes of Health. Fact Sheet on Diabetes Statistics. 12. U.S. Department of Health and Human Services, Centers for
Available online at www.diabetesniddk.nih.gov/dm/pubs/ Disease Control and Prevention, National Center for Health
statistics/index.htm#13/Accessed September 2, 2004. Statistics. CDC growth charts: United States. Advance Data,
4. Food and Nutrition Board, Institute of Medicine. Dietary No. 314, June 8, 2000 (revised). Available online at
Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Protein www.cdc.gov/growthcharts/Accessed September 2, 2004.
and Amino Acids. Washington, DC: National Academy Press, 13. Daniels, S. R., Morrison, J. A., Sprecher, D. L., et al. Association
2002. of body fat distribution and cardiovascular risk factors in children
5. American Dietetic Association. Dietary guidance for healthy and adolescents. Circulation 99:541–545, 1999.
children aged 2 to 11 years. J. Am. Diet. Assoc. 104:660–677, 14. Nutrition and Health Promotion Program, International Life
2004. Sciences Institute. A survey of parents and children about
6. Obarzanek, E., Kimm, S. Y., Barton, B. A., et al. Long-term physical activity patterns. September–October 1996. Key
safety and efficacy of a cholesterol-lowering diet in children with findings. Available online at www.ilsi.org/nhppress.html#2/
elevated low-density lipoprotein cholesterol: Seven-year results of Accessed July 31, 2002.
the Dietary Intervention Study in Children (DISC). Pediatrics 15. U.S. Department of Agriculture, U.S. Department of Health
107:256–264, 2001. and Human Services. Nutrition and Your Health: Dietary
7. Institute of Medicine, Food and Nutrition Board. Dietary Guidelines for Americans, 4th ed. Home and Garden Bulletin
Reference Intakes for Water, Potassium, Sodium, Chloride, and No. 232. Hyattsville, MD: U.S. Government Printing Office,
Sulfate. Washington, DC: National Academy Press, 2004. 2000.
8. National Institute of Child Health and Human Development. 16. Wolraich, M. L., Wilson, D. B., and White, J. W. The effect
Milk Matters. Why Calcium? Available online at of sugar on behavior or cognition in children: A meta analysis.
www.nichd.nih.gov/milk/whycal/enough_cal.cfm/ JAMA 274:1617–1618, 1995.
Accessed September 2, 2004. 17. Breakey, J. The role of diet and behavior in childhood. J. Paediatr.
9. Centers for Disease Control and Prevention. Recommendations Child Health 33:190–194, 1997.
to prevent and control iron deficiency in the United States. 18. Farley, D. Dangers of lead still linger. FDA Consumer 32:16–21,
MMWR Recomm. Rep. 47:1–29, 1998. January/February 1998.
486 Chapter 13 Nutrition from 2 to 102
19. CDC. Surveillance for Elevated Blood Lead Levels Among at http://www.cdc.gov/mmwr/preview/mmwrhtml/
Children—United States, 1997–2001. MMWR 52:1–21, 2003. mm5206a2.htm/Accessed September 2, 2004.
Available online at www.cdc.gov/mmwr/preview/mmwrhtml/ 35. U.S. Department of Health and Human Services. Administration
ss5210a1.htm#top/Accessed September 2, 2004. on Aging. 1997 Census Estimates of the Older Population.
20. Fackelmann, K. Hypertension’s lead connection: Does low-level Available online at www.aoa.dhhs.gov/aoa/stats/99pop/
exposure to lead cause high blood pressure? Sci. News default.htm/Accessed February 17, 2001.
149:382–383, 1996. 36. Stevens, J., Cai, J., Pamuk, E. R., et al. The effect of age on the
21. Update: Blood lead levels—United States, 1991–1994. MMWR, association between body-mass index and mortality. N. Engl. J.
46:141–146, 1997. Med. 338:1–7, 1998.
22. Hindin, T. J., Contento, I. R., and Gussow, J. D. A media literacy 37. Masoro, E. J. Caloric restriction and aging: An update.
nutrition education curriculum for Head Start parents about the Exp. Gerontol. 35:299–305, 2000.
effects of television advertising on their children’s food requests. 38. Institute of Medicine, Food and Nutrition Board. Dietary
J. Am. Diet. Assoc. 104: 192–198, 2004. Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6,
23. Andersen, R. E., Crespo, C. J., Bartlett, S. J., et al. Relationship Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline.
of physical activity and television watching with body weight and Washington, DC: National Academy Press, 1998.
level of fatness among children: Results from the third National 39. Russell, R. M. New views on the RDAs for older adults.
Health and Nutrition Examination Survey. JAMA 279:938–942, J. Am. Diet. Assoc. 97:515–518, 1997.
1998.
40. Christen, W. G. Antioxidant vitamins and age-related eye disease.
24. Food and Nutrition Board, Institute of Medicine. Dietary Proc. Assoc. Am. Physicians 111:16–21, 1999.
Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D,
41. Blumberg, J. Nutritional needs of seniors. J. Am. Coll. Nutr.
and Fluoride. Washington, DC: National Academy Press,
16: 517–523, 1997.
1997.
42. Proctor, D. N., Balagopal, P., and Nair, K. S. Age-related
25. USDA Agriculture Research Service. 1997 Results from USDA’s
sarcopenia in humans is associated with reduced synthetic rates
1994–1996 CSFII and 1994–1996 Diet and Health Knowledge
of specific muscle proteins. J. Nutr. 128:351S–355S, 1998.
Survey. ARS Food Surveys Research Group. Available online at
www.barc.usda.gov/bhnrc/foodsurvey/pdf/dhks9496.pdf 43. National Center for Health Statistics. Fast stats A to Z, arthritis.
Accessed September 16, 2004. Available online at www.cdc.gov/nchs/fastats/arthrits.htm/
Accessed September 16, 2004.
26. Food and Nutrition Board, Institute of Medicine. Dietary
Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, 44. Brief, A. A., Maurer, S. G., and Di Cesare, P. E. Use of
Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, glucosamine and chondroitin sulfate in the management of
Nickel, Silicon, Vanadium, and Zinc. Washington, DC: osteoarthritis. J. Am. Acad. Orthop. Surg. 9:71–78, 2001.
National Academy Press, 2001. 45. American Academy of Family Physicians. The nutrition checklist.
27. Iron Deficiency—United States, 1999–2000. MMWR Available online at www.aafp.org/nsi/Accessed September 2,
51:897–899, 2002. Available online at www.cdc.gov/mmwr/ 2002.
preview/mmwrhtml/mm5140a1.htm/Accessed September 2, 46. American Academy of Family Physicians. Nutrition Screening
2004. Initiative. Available online at www.aafp.org/nsi/index.hxml/
28. American Dietetic Association. Timely statement of the Accessed September 2, 2004.
American Dietetic Association: Nutrition guidance for 47. Russell, R. M., Rasmussen, H., and Lichtenstein, A. H. Modified
adolescent athletes in organized sports. J. Am. Diet. Assoc. food guide pyramid for people over seventy years of age. J. Nutr.
96:611–612, 1996. 129: 751–753, 1999.
29. Terjung, R. L., Clarkson, P., Eichner, E. R., et al. American 48. Administration on Aging. A Profile of Older Americans: 2002.
College of Sports Medicine Roundtable: The physiological and Available online at www.aoa.gov/prof/Statistics/profile/8.asp/
health effects of oral creatine supplementation. Med. Sci. Sports Accessed September 2, 2004.
Exerc. 32:706–717, 2000. 49. U.S. Department of Health and Human Services. Administration
30. Beals, K. A., and Manore, M. M. Nutritional status of female on Aging. Fact Sheets. The Elderly Nutrition Program. Available
athletes with subclinical eating disorders. J. Am. Diet. Assoc. online at www.aoa. gov/press/fact/alpha/fact_elderly
98:419–425, 1998. nutrition.asp/Accessed September 16, 2004.
31. Bazzarre, T. L. Nutrition and strength. In Nutrition in Exercise 50. Roe, D. A. Development and current status of home-delivered
and Sport, 3rd ed. Wolinski, I., ed. Boca Raton, FL: CRC Press, meals programs in the United States: Are the right elderly served?
1998, 369–419. Nutr. Rev. 52:29–33, 1994.
32. CDC. Deaths: Preliminary data for 2001, National Vital 51. American Dietetic Association. Nutrition, aging and the
Statistics Reports. Vol 55, March 14, 2003. Available online at continuum of care. J. Am. Diet. Assoc. 100:580–595, 2000.
www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_05.pdf/ 52. American Medical Association. Harmful Consequences of
Accessed September 2, 2004. Alcohol Use on the Brains of Children, Adolescents and
33. WHO. The World Health Report, 2001. Healthy life College Students, 2002. Fact Sheet. Available online at
expectancy. Available online at www.who.int/whosis/hale/ www.ama-assn.org/ama/pub/category/9416.html/
hale.cfm?pathwhosis,hale&languageenglish/Accessed Accessed September 2, 2004.
September 16, 2004. 53. MMWR Surveillance Summaries, August 22, 2003. Vol 52,
34. CDC. Public health and aging: Trends in aging—United States No SS-8. Available online at www.cdc.gov/mmwr/PDF/ss/
and worldwide. MMWR 52;101–106, 2003. Available online ss5208.pdf/Accessed September 2, 2004.
References 487
54. National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert 57. Ruh, J. C. Wine and polyphenols related to platelet
No. 16 PH 315 Available online at www.niaaa.nih.gov/ aggregation and atherosclerosis. Drugs Exp. Clin. Res.
publications/aa16.htm/Accessed September 2, 2004. 25:125–131, 1999.
55. Chick, J. Alcohol, health and the heart. Alcohol 33: 576–591, 1999. 58. Diebolt, M., Bucher, B., and Andriantsitohaina, R. Wine
56. Cleophas, T. J. Wine, beer and spirits and the risk of myocardial polyphenols decrease blood pressure, improve NO
infarction: A systematic review. Biomed. Pharmacother. vasodilatation, and induce gene expression. Hypertension
53:417–423, 1999. 38:159–65, 2001.