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Nutrition in Aging LBM Loss•Sarcopenia –Normal

Nutrition in Aging

LBM Loss•Sarcopenia –Normal, age related loss of muscle–Begins at 30-40y and diminishes at a steady rate–Healthy 80yo can lose ~40% of LBM as compared to when they were 30yo•Atrophy–Older adults who are bedridden–Hip fx

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Macronutrient Needs•Protein1-1.2g/kg –May be affected by dz or stress•Energy20-25kcal/kg–Usually lower due to BMR•This is dependent on other co-morbidities

Micronutrient Needs•Minerals–Ca–Zinc–Fe•Vitamins–B6, Folate, B12–Vit D, C,E, betacarotene, and K

Vitamin D deficiencyTest Results & TxClassificationng/mLSupplementation & RepletionDeficient30Provide 2000IU/day of Vitamin D3Optimal 50-80Provide 1000IU/day of Vitamin D3 to maintainExcess>150 Not common

Fluids•30 ml/kg•1 -1.5 ml/kcalor100 mL/kg for the first 10 kg body wt50 mL/kg for the next 10 kg body wt20 mL/kg for the remaining kg body wt•Minimum of 1500ml/d + 900ml from food

Osteoporosis•Prevention–Diet adequate in kcal, pro, Ca, Vit D–Supplemental Ca, Vit D–Weight bearing exercise–Hormonal therapyCalcium-1500mg/d

Hip Knee Replacements•Nutritional Intervention:–Adequate kcal to maintain IBW–? pro to 1.2g/kg–Adequate micronutrients esp. Ca/ Vit D

Pneumonia•Tx:–Antibiotics–Ventilator•Nutrition Intervention:–Adequate kcal to maintain IBW–? pro to ~1.2 g/kg–Monitor appetite and weight status

Alzheimer’s Dz•Shrinkage of size and wt of brain•Effects memory and cognition•Terminal AD involves atrophy and damage through the entire brain•Familial AD associated with abnormal apo-E•Labs: no specific•Tx:–ACTH inhibitors: Aricept, Exelon, Reminyl–Glutamate Receptor Inhibitor: Namenda

Alzheimer’s Dz•Nutritional Concerns:–Wt loss–Depression–Social withdrawal–Dementia and Inappropriate behavior•Nutritional Intervention:–Adequate Kcal/pro to maintain IBW–Finger foods–Minimize confusion in the environment–Frequently offer meals and snacks–Adequate hydration

Pressure Ulcers•Nutritional Recommendations–KCAL30-35 kcal/kg body weight–PRO1.25-1.5 g/kg body weight–Fluid1 ml/kcal/day–Vit Amultivitamin, higher with steroid use–Vit C500-1000 mg if def or Stg III or IV–ZnSo4 220mg BID for 2 weeks

Nutritional Goals for Wound Healing •Provide adequate energy to maximize nitrogen retention and facilitatewound healing•Provide adequate protein for positivenitrogen balance•Provide 100% of the RDA or adequateintake for vitamins andminerals daily •Treatsuspected or confirmed vitamin and mineral deficiencies,especially zinc,vitamins A and C.•Monitor outcomes of food and supplementsabove the tolerableupper intake limits to avoid nutrient toxicity

•Maintain optimal hydration status and perfusionto wounded tissues•Maintain glycemic control•Monitoradequacy of nutrient intake•Monitor actual vsdesired outcomesfrom nutrition interventions

Supplementation•Arginine –Increases collagen production, N balance•Glutamine–Improved N balance•B-Hydroxy methylbutyrate –Increases collagen production •Limited data

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