NUTRITION MODULE 7 The Scientist Brian Wansink once

NUTRITION MODULE 7

The Scientist Brian Wansink once invited 86 Experts of nutrition to a dinner. . 53 % Eat more ice than those who were given a small plate and a small spoon.

Something funny to reflect about Those who ate ice from big deep plates, ate more than 30 percent more ice cream than those, who had the flat plate

We are all well raised and behaved – so we all try to eat, all we have on our plates. 73 percent more Soup.

Eat alone Eat together with another person 33% more Eat together 7 people 96 % more

Let`s look – at once upon a time What we think is one of our times biggest successes and achievements – is that we can afford to have our own place. Great – grand parents Grandparents WHAT CAN WE LEARN FROM THESE SMALL STORIES/INFO ABOUT

• In an education course for seniors about these conditions regarding food and eating habits, it turned out that 7 out of the 11 participants had lost their spouses. • Responding to the question ‘how often do you have guests for lunch or dinner or are invited for lunch or dinner’ – most of them answered; Typically once a week maybe only every 2 weeks or even more rarely. The 7 seniors lived within a very small radius of each other and everyone answered they normally had all their meals alone.

Eating so many meals alone, increase the risk that we • Eat less and finally too little and slowly lose weight. • Eat with less and less variation and become at risk of malnutrition. It takes double as long to eat every food item we buy – compared to when you are 2 eating the same food item. So we buy less – and we buy with less variation. Can anyone recognise that?

Underweight occurrence Studies show that malnutrition is common among elderly patients who are hospitalized, live in a nursing home or receive regular help from home care. It is estimated that more than every other elderly in need of care has a body mass index (BMI) below the ideal. So what is the important question having this information? Are the hospitals starving people – are people starving when in need of home care or ?

. When elderly become malnourished, it increases the risk of ending up with a combination of protein and calorie deficiency. Of ending up lacking trace elements (vitamins, minerals)

Analyses show, among other things, that chronic diseases or disorders are particularly common among the elderly. Thus, 45% of the population over 85 years have at least one of the following chronic diseases: COPD, rheumatoid arthritis, bone loss, type 1 or 2 diabetes, heart failure and asthma. Many suffer from different diseases from those mentioned 73% of seniors having a chronical disease – disability is underweight, shows a measuring at Danish hospitals. Bad nutritional status contributes to the development of chronic disorders

Malnutrition is common in chronic illness. In a dissertation, nutritional status was estimated for approximately 1, 300 people older than 65 years, (average 85 years) of which 73% were in the risk group. Are 73% of hospitalized seniors underweight because the hospitals in Denmark starve the senior patients? Or Are the underweight a part of the reason for these seniors with a chronical disease being hospitalized?

After three years one found a connection between malnutrition, low body mass index and death.

The challenges of overweight • • • Type 2 diabetes cardiovascular disease blood clots Blood clots in the brain Gallstones uric acid osteoarthritis in the hand, knees and hips breast cancer cervical cancer colon cancer kidney cancer

The challenges of underweight – Malnutrition Poor nutrition in the elderly lead to : • Reduced ability – more tired • Increased morbidity • Reduced ability to take care of themselves • Reduced well-being • Reduced quality of life in the elderly. • It weakens the immune system

So what is BMI – Body Mass Index? Lower and lower BMI is not normal just because you and we become older and older. One should be aware and have it investigated and clarified in case it happens.

What is BMI – What is your BMI Studies shows when it comes to 60+ that: The lowest death rate is identified among women who had a BMI between 23 – 25 Under weight Up to 18, 5 Heading for 18, 5 to 24, 9 Increasingly negative influence on health 25 to 29, 9 30 to 34, 9 More than 34 The lowest death rate is identified among males who had a BMI between 26 – 28

- The brilliant part of being a male celebrating one’s 60 th birthday. The day before my 60 th birthday having a BMI at 25 or 26 or perhaps even more – I might be considered as close to be overweight – The day after I am almost a slim senor having a BMI at 28

How much do we have to eat. ? What do we use all the food and liquid for?

As a basic guideline we need approximately between 1, 800 to 2, 200 kcal per day. . What do we use all that energy for? Our brain need 360 – 440 kcal App. 20% The kidney 180 – 220 kcal App. 10% Our heart 144 to 176 kca. App 6 to 8 % Our lever 360 – 440 kcal. App 20% Our muscles 240 – 330 kcal App 15% Our fat tissue 108 – 175 kcal. App 6 – 8 % For digestive 126 – 286 kcal. App – 13% Other function and tasks App 2 – 4 %

7 kcal not used is saved as 1 gram of fat. It is possible to calculate our daily need of kcal.

How much do we need? Most of what we eat on a daily basis is to keep our body and mind operating -

100 kcal or 500 kcal too much once in a while is not the problem 14 kcal too much on average daily basis. 2 gram of fat 365 days a year 730 gram a year 7. 3 kg in 10 year Basically not a big problem to most of us. 28 kcal too much on average daily basis. 4 gram of fat 365 days a year 1, 460 gram a year 14, 600 gram a year Probably a problem to most of us. Turn it around - having 28 kcal too little every day. Losing 14. 6 kg in 10 years might be a problem to some's health

• With age, the weight and height of many older people drop. • Among the people who were followed for 25 years the average height was reduced by: • 5 cm for women and the average weight by 5. 1 kg. • 4 cm men and the average weight by 3. 2 kg For some, it's good that weight drops a bit - for many of us it's a problem that grows through old age. THAT WE LOOSE WEIGHT AND FINALLY HAVE LOST TOO MUCH WEIGHT. .

We become shorter MALES become 4 cm shorter MALES lose on average 3. 2 kg during the senior period FEMALES become 5 cm shorter FEMALES lose on average 5 kg during their senior period

WHY DO WE GET SHORTER AND SHORTER: 1) It is of course the impact of gravity. In fact most of us are shorter when we go to bed – compared to when we get out of bed from a very young age.

WHY DO WE GET SHORTER AND SHORTER: When we become shorter and shorter in later life and don`t manage to get strecthed out again during the night – it’s partly caused because less physical activity weaken our mucsles and don`t have the muscle strength to pull out again. It increases the risk of having a discusprolapse.

What does it mean to be thin/fat The term "thin fat" refers to a person who is not overweight, but where the body's fat mass is still so high that it has consequences for the health.

total weight is 75 kg 25% muscles Age 65 15% fat total weight is 75 kg 20% muscles Age 75 20 % fat 15% muscles 25% fat Age 75 We keep our BMI at a good level , but inside we slowly change the balance between fat and muscles due to a more and more reduced level of physical activity and maintenance of our muscles.

BMI 30 BMI 29 25% muscles Age 65 BMI 28 20% muscles 15% fat Age 75 20 % fat 15% muscles 25% fat Age 75 we slowly reduce our weight to the right level of BMI, and believe we are on the right track – but basically we don`t change the health-perspective, because of inactivity we slowly change the distribution of fat and muscle in the favour of more fat. From one challenge to another challenge

MEAUSURING YOUR FAT PRECENTAGE Many different tools

Measure the fat percentage as accurately as possible The best option is to get a partner to help with the fat percentage measurement and it should also be the same person who measures the fat percentage each time. Thumb and index finger are used to pull out a skin fold. Do not squeeze harder than necessary. The measurement is made 1 cm next to the fingers and the grease pointer is read within 3 seconds.

GO to https: //www. bodylab. dk/maalfedtprocent. asp MEASURING 4 PLACES Shou lder Biceps Age blad e ps Iliac crest Biceps Triceps Age Sex Iliac crest M F Shoulder blade Fat percentage Fat free bodyweight

Recommendations Fat percentage

IT MATTERS WHERE WE PLACE THE FAT WAIST CIRCUMFERENCE

THERE ARE DIFFERENCES ON FAT

OMEGA 3 PREVENTS arteriosclerosis, blood clot, cancer, diabetes, dementia, depression, arthritis, asthma, psoriasis, eczema, and bowel inflammation. Omega-3 fatty acid DHA accounts for 20 percent of the brain's fats and is important for the brain's structure and function, including for mood and memory. Omega-3 helps relieve pain, lower blood pressure and reduce blood fat. FISH – Fat fish – the smaller fish the better. Fish from nature.

PROTEINS

When we eat less and eventually too little – we not only get weight problems – but especially we are having trouble eating proteins enough – we do not get enough protein.

PROTEINS Proteins are built by 20 amino acids 12 out of these 20 amino acids – we are able to build our selves 8 out of these 20 amino acids – have to come from the food we eat.

PROTEINS Are a key part of malnutrition problems and are associated with • dysfunctional immune system, • anemia, • impaired muscle function, • reduced bone mass, • decreased cognitive function, • poorer wound healing (shinbone wound) • delayed recovery after surgical procedures and ultimately increased morbidity and mortality.

The need for protein for a healthy person is about 1 gram per kilo body weight per day. The need for protein for a senior person is about 1. 2 g protein per kg body weight Weight loss or losing appetite 1. 2 g up to 1. 5 protein per kg body weight Kg body Adult Seniors losing weight and appetite 40 kg 40 gram 48 gram 60 gram 50 kg 50 gram 60 gram 75 gram 60 kg 60 gram 72 gram 90 gram 70 kg 70 gram 84 gram 105 gram 80 kg 80 gram 96 gram 120 gram 90 kg 90 gram 108 gram 135 gram

Vitamins, minerals and fibers and more

Many of us are advised to take dietary supplements. especially taking vitamin pills from we were children. Some of us also have a phrase in mind from our childhood "it never hurts to take a vitamin pill or iron supplement or more“ Many of us are raised with a daily vitamin pill.

2/3 of all older than 70 years on a random day take medicine, half take more than two types of medicine and one fifth more than five different kinds. In addition, non-prescription drugs, supplements and herbal remedies are popular with some older people. Does the Danish figures - count for you to? Many older people take a subsidy of iron, calcium and dietary fiber, not knowing that it reduce the inclusion/effect of a number of drugs.

Danish health authorities "Vitamin supplements have changed from preventing nutritional deficiencies to trying to promote wellness & to prevent disease. We cannot recommend the use of vitamin and mineral supplements as a preventive measure, at least not in a well-nourished population "

Does it count for someone here? Do you have a daily intake of these different things. Many healthy people eat dietary supplements in the form of different vitamins and minerals. Studies indicate that there are people who already live healthy to supplement dietary supplements. In the vast majority of cases, the pills are unnecessary and the money would be better spent buying better food.

Scientists have studied nearly 40, 000 women Followed them for 20 • years. Most of the women were in their 50 s and 60 s at the start. The study showed: Women who took multivitamins, folic acid, vitamin B 6, magnesium, zinc and copper were at greater risk of dying within the study period than the women who did not take these supplements.

Scientists have studied nearly 40, 000 women Followed them for 20 • years. Most of the women were in their 50 s and 60 s at the start. The greatest increased risk is seen by the intake of iron supplementation. Here the researchers argue that it was "particularly worrying" that the risk of death rose the more iron supplements the women took.

There are scientific evidence telling that a lack of D-Vitamin cause muscle weakness among senior citizens. SUN is the best source for D Vitamin. Capacity reduces to 2/3 compared to earlier in life. .

The importance of calcium supplements to reduce the risk of fractures in the elderly has been extensively studied. The results are partly contradictory - but the available data suggest that calcium supplementation in combination with vitamin D may reduce the risk of fractures especially in older women. What we know prevent falls and fracture is phycical activity and exercise.

OSTEOPOROSIS PHYSICAL EXERCISE - CALCIUM Vitamin D

CONCLUSION • Based on the existing documentation, we do not see much justification for the general and widespread use of vitamin and dietary supplements. • A healthy and varied diet ensures that the body is maintained. With a versatile diet, it will hardly be a problem to meet the need for vitamins, minerals and proteins. Except for vitamin D and calcium. Danish Health Authorities “We recommend VITAMINS only to be used when there is strong medical reasons, such as malnutrition diseases. "

There are scientific indications that fibres and antioxidants do have a preventive effect towards cardiovascular diseases and cancer.

We lose approximately 2. 5 litre in general every 24 hours. • • as urine, stool, vaporization from the air we exude, as sweat and evaporation from the skin. Because we sleep about one third of our lives, then you spend a part of the 0. 5 litre at night when you sleep.

More meals with someone More physical activity – stimulate our appetite Enough protein Enough vitamin D and calcium Don`t mix medicine and supplements without consulting your doctor Take care of your weight and fat percentage

Thank you for your attention – any questions? Let’s do some tests and measuring