Inside the Changing American Diet


TIME

As Bryan Walsh notes in this week’s magazine, the decades-long vilification of fat has driven people to eat more sugar and carbohydrates, which new research suggests may be the chief drivers of rising obesity and Type 2 Diabetes. Here’s a look at how what fills the American plate has evolved over the last 40 years.

Slide the year below to see how consumption patterns have changed. Select each food group to see the changing make up of each over the years.

[time-interactive id=food-interactive]

The data shows that Americans have greatly increased their consumption of poultry in lieu of red meat. In 2004, chicken overtook beef as the most consumed meat in the country. Similarly, dairy products declined markedly in popularity as vegetable and grain consumption increased.

Methodology
Data for food consumption is provided by the United States Department of Agriculture’s National Nutrient Database. Figures represent the “loss-adjusted availability”…

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Nutrition for Older Adults


elderly

For the past few months, I have been working as a Registered Dietitian for two nursing homes in the Pittsburgh, PA area. Because I did not have a long-term care rotation during my dietetic internship, this has been my first opportunity working with the elderly. I have been gaining invaluable experience learning about the nutritional issues and needs of the aging population and applying that knowledge to help residents in a skilled nursing facility.

The golden question I know everyone is wondering is, “Sooooo, exactly how old is…OLD?” Well, according to The Academy of Nutrition and Dietetics, the category of “older adults” includes those aged 60 years and older (or about 1 in every 8 individuals in this country).

Before I have some of my reader’s up in arms about the 60 year “young” marker, I will put a disclaimer out there that I sincerely believe there is a distinct difference between someone’s “chronological age” and someone’s “physiological age”. Someone’s physiological age is a person’s age as estimated from their body’s health, while someone’s chronological age is person’s actual age in years from their date of birth

Regardless of your beliefs, it is hard to ignore the fact that “baby boomers” are now reaching retirement age and the number of older adults is thus “booming” at a rapid pace. From 1990 to 2010, the percentage of Americans 65 years or older increased from 4.1% to an astonishing 13.1% of the total population. Not to mention, with the advancements in healthcare and technology, Americans are now living longer than ever. To illustrate this, I really like this interactive map of the United States, which demonstrates the increased life expectancy over the past 25 years. According to the CDC, the life expectancy is 81.1 years for females and 76.6 years for males. Unfortunately, many of the elderly may end up in a nursing home, skilled nursing facility, or assisted living facility. In the U.S., over 1.5 million residents are living in nursing homes…88% of those are 65+ years old. And these individuals aren’t just staying for a month or two either. According to the 2004 CDC National Nursing Home Survey, the average length of stay is 835 days.

Why does nutrition play such an important role in the health of older adults? To start, nutrition has a major influence on 5 out of the 8 most common causes of death in older adults (see figure below). Secondly, 80% of older adults have at least one chronic disease, with about 50% having 2 or more chronic diseases.  Diet not only plays a MAJOR role in the prevention of chronic diseases, diet also helps to minimize their complications and associated risks (thus having a factor in your physiological age). common cause of death 65

There are many health, physiologic, and functional factors that change our nutritional status and nutritional needs as our bodies age.

1.) Medical/Health Status

  • Presence of chronic or acute illness
  • Medications
  • Sensory changes – taste, smell, appearance, texture
  • Disability and immobility
  • Oral health – Missing teeth and ill-fitting dentures can effect your ability to chew

2.) Physical/Functional Status

  • Physical limitations
  • Balance
  • Physical strength and endurance
  • Physical activity – There are numerous health benefits for older adults. Please refer to the figure below.

physical activity benefits in older adults

3.) Cognition and Mental Status

  • Change in mental status
  • Education level
  • Depression – Nearly 19% of adults 65 years and older suffer from depression.
  • Emotional needs
  • Habitual food intake
  • Health/nutrition-related beliefs
  • Advertising

4.) Environmental Status

  • Living situation – About 29% of non-institutionalized older adults live alone, making it more difficult for them to prepare meals.
  • Economics
  • Cultural beliefs and traditions
  • Religious beliefs and traditions
  • Environment
  • Lifestyle
  • Access to food and proper food storage/preparation
  • Socialization – Living alone versus living with a family member

5.) The Nutritional Needs Of Older Adults

  • Energy – There is about a 15% decrease in calorie needs between age 30 and age 80. With decreasing physical activity, lean muscle mass diminishes and fat mass increases. To estimate calorie needs:

– For men: subtract 10 calories/day for every year of age above 19

– For women: subtract 7 calories/day for every year of age above 19

  • Protein – Evidence has found that dietary intake of protein declines with age, despite the fact that the body’s protein requirements generally stay the same throughout life. (Click here to find out how much protein you should be consuming). It is recommended for adults to consume about 30 grams of high-quality protein at each meal, or a total of 0.8 grams of protein for every kilogram of body weight. Protein malnutrition can lead to other health complications such as muscle wasting, fatigue, and sarcopenia. In long-term care, we measure an individual’s protein needs based on their serum albumin or pre-albumin levels (which is a measure of a visceral protein status or lean muscle mass).
  • Nutrients – Many nutrient needs stay the same throughout the lifespan. Because of decreased energy expenditure and decreased caloric requirements, this makes it difficult for individuals to consume an adequate amount of nutrients while still consuming less calories.
  • Vitamin D and Calcium – These are two important nutrients older adults should be consuming through their diet due to increased risk of osteoporosis. However, many do not consume enough through dietary sources and thus resort to supplementation. Diet daily requirements for calcium and vitamin D are:

Calcium – 1200 mg/day

Vitamin D – Adults 51-70 years old need 10 mcg/day and adults 70+ need 15 mcg

  • Vitamin B-12 – To prevent anemia, older adults should be consuming the RDA of vitamin B-12, which is 2.4 mcg. Older adults are at a greater risk for vit. B-12 deficiency due to malabsorption, lack of intrinsic factor, atrophic gastritis, and poor diet.
  • Hydration – Dehydration can be a major concern for older adults because many do not consume adequate amounts of water.  There are multiple reasons for this, including: decreased perception of thirst, endocrine changes, alterations in cognitive status, side effects of medications,  fear of incontinence, and immobility. An individual’s estimated fluid needs is about 25-30 mL of water for every kilogram of body weight.

 

Lastly, here is an easy and quick tool that I like to use to DETERMINE if someone over the age of 65 is at risk for malnutrition.

Disease – Do you have any chronic illnesses that changes what you need to eat?

Eating poorly – How is your appetite? How many meals a day do you eat? Do you eat fruits and vegetables?

Tooth loss or mouth pain – Do you have problems chewing such as ill-fitting dentures?

Economic hardship – Do you have enough money to buy the types of foods you need?

Reduced social contact – Do you eat alone or with others?

Multiple medications – Do you take 3 or more prescribed or over-the-counter medications?

Involuntary weight loss or gain – Have you lost or gained more than 10% of your body weight over the past 6 months?

Needs assistance – Are you physically able to shop, prepare foods, cook, and feed yourself?

Elderly person – Are you over the age of 80?

 

Sources:

Position of the Academy of Nutrition and Dietetics: Food and Nutrition for Older Adults: Promoting Health and Wellness

www.cdc.gov

Join the Pittsburgh Dietetic Association!


This is the first year I joined the Pittsburgh Dietetic Association (PDA). This association has allowed me to network with other dietitians in my area, connect with new people, and participate in opportunities for continuing education credits. I am very excited because I will be contributing to the organization’s social media sites. If you are an RD, RD-to-be, DTR, or dietetics student in the Pittsburgh area, please visit PDA’s website for more information on becoming a member.

Also, please like and follow PDA on Facebook, LinkedIn, and Twitter!

Scheduled: RD Exam!


After over 1200 hours of supervised practice throughout my dietetic internship at WVU, I am finally eligible to take the RD (Registered Dietitian) exam! It’s been a long, long road, but this comprehensive exam is the final step towards becoming a Registered Dietitian.

The RD exam consists of 4 domains:

DOMAIN I: Principles of Dietetics (12% of exam)

A. Food Science and Nutrient Composition of Foods

B. Nutrition and Supporting Sciences

C. Education and Communication

D. Research

E. Management Concepts

DOMAIN II: Nutrition Care for Individuals and Groups (50% of exam)

A. Screening and Assessment

B. Diagnosis

C. Planning and Intervention

D. Monitoring and Evaluation

DOMAIN III: Management of Food and Nutrition Programs and Services (21% of exam)

A. Functions of Management

B. Human Resources

C. Financial Management

D. Marketing and Public Relations

E. Quality Improvement

DOMAIN IV: Foodservice Systems (17% of exam)

A. Menu Development

B. Procurement, Production, Distribution, and Service

C. Safety and Sanitation

D. Equipment and Facility Planning

E. Sustainability

I have scheduled my exam for one month from now (mid-July). I already ordered Jean Inman’s review course and CD’s and have been slowly reviewing the material. I also have two RD exam prep apps on my iPhone for studying on the go. However, I would love to hear any tips/suggestions/advice from anyone who has already taken the RD exam! Please feel free to comment below. 🙂

Ah, I’m so nervous/scared, but now it’s off to study! Wish me luck 🙂

I Am On The Job Hunt!


Now that graduate school is coming to a close, it is now time for me to move on to the next stage of my life. Eek! So nerve-racking, yet I am SO excited to start my dietitian career.

For employers:

I will be graduating in May from West Virginia University with an MS in Nutrition and Food Science and will be taking the Registered Dietitian (RD) examination in mid-June. I am currently seeking employment around the Pittsburgh, PA area. If you know of any companies or healthcare facilities who are hiring dietitians that meet my qualifications, please do not hesitate to contact me!

Thank you 🙂

HMB Supplementation and Athletic Performance in Exercised Adults


This was an hour-long, graduate-level presentation I gave in a nutrition seminar course. The audience was master’s students and professors in the West Virginia University Animal & Nutritional Sciences Department.

 

Childhood Obesity: “5, 2, 1, 0” & Staying Fit in Monongalia County


The Women, Infants, and Children (WIC) program has been promoting the “5, 2, 1, 0” message to prevent childhood obesity. The message “5, 2, 1, 0” message consists four major components:

  • Eat 5 fruits and vegetables a day
  • Limit screen time to 2 hours or less per day
  • Get 1 hour or more of physical activity every day
  • Drink fewer or 0 sugar-sweetened drinks

5210

In honor of this healthy message, staff from local West Virginia WIC offices comprised a list of inexpensive places for young children to participate in daily physical activity in Monongalia County, WV. The list is below:

If you have any other ideas to add to the list, please leave a comment below!

Community Nutrition Rotation at WIC


For the past two weeks, I have been on a community nutrition rotation at WIC. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Each county in the state of West Virginia has it’s own WIC office. I have had the opportunity to shadow a registered dietitian at the Monongalia County WIC office located in Morgantown, WV.

WICpanweb

WIC provides the following services for eligible participants:

  • Free vouchers for specific, nutritious foods
  • Nutrition education in the form of one-on-one counseling with a dietitian, group classes, or grocery store tours
  • Free immunizations for children
  • Breastfeeding services in the form of one-on-one counseling with a lactation consultant. Breastfeeding pumps are also available for lactating mothers in a limited supply
  • Screening and referrals to other health, welfare and social services

Who is eligible to receive WIC benefits?

Participants must meet all three of the following requirements:

1.  Category

  • Pregnant women
  • Postpartum women (up to 6 months after pregnancy)
  • Infants (up to the infant’s 1st birthday)
  • Children (up to age 5)

2.  Income Level

  • Applicant must meet USDA income standards which are revised each year. Any applicant that has a current medical card, proof of food stamps or TANF eligibility is automatically income eligible for WIC benefits.

3.  Nutritional Risk

  • A nutrition and health assessment includes: height & weight measurements, anemia (low hemoglobin levels), health history & diet assessment.

Food Vouchers

WIC participants receive food vouchers that can be used at local grocery stores (and Wal-Mart).  A new offer from WIC is that participants can now receive a special $20 farmer’s market voucher to spend at local farmer’s markets on fresh fruits and vegetables!

The quantities of foods depend on the type of participant. For example, breastfeeding mothers require more food than mother’s who are not breastfeeding.  The types of foods that participants can receive with their vouchers include:

  • 4 cans of beans, 1 package of dried beans, OR a jar of peanut butter
  • 16 oz of sliced, cheddar, or blocked cheese
  • Eggs
  • Bread
  • Milk (whole, 2%, 1%, or skim)
  • Cereal (only certain brands)
  • 100% juices
  • $10 or $6 voucher for fresh fruits and vegetables
  • Infant baby foods and formula

For a full list of WIC approved foods starting February 1, 2013, click here.