محاضرة 10

Nutrition
Lecturer 10
Factors affecting diet and nutritional
status in older adults
nutritionist Clinical /Dr. Hamas Swiaed
factors affecting nutritional status of the elderly
The hypothesis was that social and economic factors such as low
educational level, living alone, being single, low income level,
gender, residence, employment status, lifestyle and depression are
related to nutritional status of the elderly.
Satiety
Satiety is the lack of appetite or hunger for a period following a

meal. It is largely controlled by a combination of humoral
signals in response to food in the gastrointestinal tract and
nutritional or physiological.
Appetite
Appetite is the desire to eat food items, usually due to

hunger. Appealing foods can stimulate appetite even when
hunger is absent, although appetite can be greatly reduced
by satiety. Appetite exists in all higher life-forms, and serves
to regulate adequate energy intake to maintain metabolic
needs.
Appetite hormones
1-Cholecystokinin (CCK) is secreted mainly by I cells in the

duodenal and jejunal mucosa, reducing appetite and slowing
gastric emptying. Cholecystokinin is thought to enhance the
nervous response to gastric distension, and CCK exerts only a
short-term effect (approximately 30 min) and thus regulates
food intake during consumption.
2-Glucagon-like peptide 1 (GLP-1) is an incretin hormone released
by L cells in the distal small intestine and colon in response to food
intake. Nutrient composition is important for the magnitude of the
response, with small sugars playing a key role. Glucagon-like
peptide 1accentuates insulin release, is thought to be involved in
the ileal brake mechanism for promoting satiety, and is sensitive to
the presence of proteins and carbohydrates. Fats also stimulate a
GLP-1 response, but the stimulation is delayed.
3-Peptide YY (PYY) is secreted by endocrine L cells from the distal
parts of the gastrointestinal tract, especially ileum, colon, and rectum.
Peptide YY mediates ileal and colonic brakes that slow gastric
emptying and promote digestive activities to increase nutrient
absorption. Dietary fat and proteins stimulate a strong response,
which is sensitive to fatty acid chain length and structure.
Dietary fiber can induce a more sustained PYY expression.
Appetite Loss and Anorexia of Aging in Clinical Care
determinants
Nutritional strategies
Physiological/Functional Swallowing/chewing problems

Poor dentition Dry mouth Reduced thirst/dehydration Modify diet prescription
Reduced taste/smell Altered gastrointestinal motility Food fortification
Decreased stomach compliance Delayed gastric emptying
Vitamin/mineral
Body composition changes Reduction in muscle mass &
basal metabolic rate Comorbidities/conditions Neurological supplements Oral
diseases nutritional supplements
(monitor the gap between
prescription and intake )
dysphagia
Dysphagia is the commonly identified problem in patients awaiting
an esophagectomy.
Causes of oral dysphagia
Causes of oral dysphagia Various reasons for this type of dysphagia can be ]:
• Bad teeth
• Problems with the jaw
• Xerostomia - dry mouth
• Tumors - cavum or is cancer, pharyngeal or laryngeal cancer
• Masses outside the pharynx, such as osteophytosis on the vertebrae that press on
pharynx
• Complication of head or neck surgery
Symptoms Signs and symptoms associated
with dysphagia may include:
• Salvia, food, liquid, or pills are sticking in the throat

• Coughing or choking food or liquid
• Sensing of a “lump” in the throat
• Having the sensation of food getting stuck behind sternum
• Wet voice
• Bringing food back up (regurgitation)
• Having food or stomach acid back up into the throat • Unexpected
weight loss
• Pain
• Developing aspirations pneumonia
Complications
Complications of Dysphagia The most common are

pulmonary complications, dehydration and malnutrition.
Diagnosis
Diagnosis When the dysphagia is frequent, and the cause is not clear, a
comprehensive evaluation of dysphagia should include several medical
disciplines . An examination begins with a clinical examination that
includes a detailed history of subjective complaints and medical status.
Treatments
Treatments for dysphagia include

1- occupational therapist or speech and language therapy to learn new
swallowing techniques,
2-using texture modified foods and thickened fluids changing the
consistency of food and liquids to make them safer to swallow.
3-sometimes other forms of feeding – such as tube feeding through the
nose or stomach
4-Surgery is used in patients who have some changes (such
as a tumor or diverticula) blocking the pharynx or
esophagus or patients who have a problem that affects the
lower esophageal muscle.
5- Dilation is used to expand any narrow areas of the
esophagus If dysphagia is related to GERD or esophagitis,
medicines may help prevent stomach acid from entering the
esophagus. Infections
Smoking/
Smoking/ burning plant material. A variety of plant

materials are smoked, including marijuana and
hashish, but the act is most commonly associated
with tobacco as smoked in a cigarette, cigar, or pipe.
Consequences of tobacco use for older adult
Tobacco smoking is a major cause of lung cancer Smoking and age-

related diseases
Smoking plays an important role also in the development of other
pathological conditions being particularly frequent in old age, such as
dementia, osteoporosis, diabetes -peptic ulcer, gastro-esophageal reflux,
erectile dysfunction, senile macular degeneration, nuclear cata- ract,
alterations of hearing and skin.
alcohol,
Ethyl alcohol, or ethanol, is an intoxicating ingredient found in

beer, wine, and liquor. Alcohol is produced by the fermentation
of yeast, sugars, and starches
Consequences alcohol of use for older adult
mental confusion, difficulty remaining conscious, vomiting,

seizures, trouble breathing, slow heart rate, clammy skin, dulled
responses (such as no gag reflex, which prevents choking),
and extremely low body temperature. Alcohol overdose can
lead to permanent brain damage or death.

محاضرة 10

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محاضرة 10

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Nutrition

Satiety is the lack of appetite or hunger for a period following a

Appetite is the desire to eat food items, usually due to

1-Cholecystokinin (CCK) is secreted mainly by I cells in the

Physiological/Functional Swallowing/chewing problems

• Salvia, food, liquid, or pills are sticking in the throat

Complications of Dysphagia The most common are

Treatments for dysphagia include

Smoking/ burning plant material. A variety of plant

Tobacco smoking is a major cause of lung cancer Smoking and age-

Ethyl alcohol, or ethanol, is an intoxicating ingredient found in

mental confusion, difficulty remaining conscious, vomiting,

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