Mary Marian

Micronutrients and Older Adults

The aging population worldwide is increasing. Although many older adults are living longer, healthier lives, aging is also associated with a variety of physiologic and psychological changes that influence nutrition status and the need for medical care. Many factors increase the risk for poor nutrient intake among older adults. Suboptimal micronutrient intake for particular vitamins and minerals is reported to be common.

Reading, Writing, and Obesity America’s Failing Grade in School Nutrition and Physical Education

The childhood obesity epidemic has left healthcare professionals and laymen alike questioning the best strategy to improve childrens health in the future. To effectively combat childhood obesity, we must have a thorough understanding of the establishment and development of programs currently responsible for pediatric health. This article explores the history of two influential programs affecting childrens diet and physical activity levels in schools: the National School Lunch Program and physical education classes. It is revealed that the National School Lunch Program contributes to the overall school nutrition environment, including the presence of fast food and vending machines on campuses. The history of physical education is traced back to ancient Greece, and it is shown that the familiar sports-based curriculum is an advent of the 19th century, with the roots of physical education originating from the founders of preventive medicine. Select childhood obesity and health intervention studies are reviewed with a focus on identifying notable features pertaining to the effectiveness of these programs. Future directions and recommendations, based on the history of these programs as well as evidence from current pediatric health studies, outlining the basis for a modernized health-based physical education curriculum designed to address todays public health concerns, are further discussed.

Nutrition support for patients in long-term acute care and subacute care facilities.

Long-term acute care and subacute care facilities (also transitional care facilities) have evolved from the need to decrease costs associated with acute care in the hospital. As the length of stay in many medical centers has been reduced, patients are admitted to transitional care facilities to continue recovery and rehabilitation. Rehabilitation and recovery can be enhanced with the provision of optimal medical nutrition therapy. Nutrition screening is essential in identifying patients who are at risk of malnutrition or are malnourished. Nutrition assessment verifies the risk or presence of malnutrition followed by the development, implementation, and monitoring of nutrition intervention. Nutrition screening and intervention promote recovery from illness, minimize morbidity and mortality, and enhance quality of life. The goals of nutrition support are to prevent starvation-associated malnutrition, preserve lean tissue mass, support metabolic functions, and improve clinical outcomes. Oral nutrition is the preferred method of nourishment; however, specialized nutrition support is considered for patients unable to meet their nutrient requirements adequately. Enteral nutrition support is recommended when providing nutrition support however, parenteral nutrition support is used when the gastrointestinal tract can not be safely used. With appropriate intention, administration, and monitoring, nutrition support can be safely administered.

An integrated nutrition curriculum in medical education.

R25 grant support from the NIH/NCI enabled the University of Arizona to assess nutrition education, develop and evaluate specific course content, and move toward comprehensive prevention-based nutrition education in 1991-1997. Hours of nutrition education increased to 115% over baseline, and students indicated greater satisfaction with the amount of nutrition instruction they received. Especially valuable was a course in prenatal and infant nutrition that paired each student with a pregnant patient. After the grant support ended, nutrition began to be crowded out of the curriculum by other, more traditional, topics, but a 57% gain over baseline was sustained. External support for nutrition education is urgently needed.

Dietary Supplements Commonly Used by Cancer Survivors: Are There Any Benefits?

Following a cancer diagnosis, dietary supplements are reportedly used by 20%–80% of individuals. Supplements are most commonly used by breast cancer survivors, followed by patients with prostate, colorectal, and lung cancers, which is not surprising since these are the most common types of cancer diagnosed in adults. Reasons cited for such use include improving quality of life, reducing symptoms related to treatment and/or the disease process, and recommendation from medical practitioners; family and friends may also be an influence. However, controversy surrounds the use of dietary supplements, particularly during treatment—specifically, whether supplements affect treatment efficacy is unknown. This article discusses the evidence related to common dietary supplements used to prevent cancer or a recurrence.

Nutrition and the Cancer Survivor

Approximately 1.6 million new cases of cancer are diagnosed annually, accounting for 22.9 % of deaths in the USA [1]. When deaths are aggregated by age, cancer has surpassed heart disease as the leading cause of death for individuals under the age of 85 years. For men, prostate cancer is the most commonly diagnosed cancer followed by lung and colorectal, while breast, lung, and colorectal cancers are the most commonly diagnosed cancers in women. These four cancers account for one-half of the total cancer deaths. Additionally in the USA, approximately 600,000 adults are expected to die annually from cancer, accounting for a little over 1500 deaths per day.

Obesity and Cancer

Obesity is a global epidemic and a wealth of evidence suggests that obesity in addition to sedentary lifestyle and diet are modifiable risk factors associated with cancer. Several cancers including breast (in postmenopausal women), cervical, colon, endometrial, esophageal, gallbladder, multiple myeloma, non-Hodgkin’s lymphoma, rectal, renal, thyroid cancer, and even pancreatic cancer have been associated with obesity. A variety of biological mechanisms involving the adipocyte has been implicated in tumorigenesis. Moreover, poorer outcomes in terms of worsened disease survival have been reported for obese patients. A number of small, randomized, controlled trials to promote weight loss in cancer survivors have been undertaken and suggest modest results in relation to weight control. This chapter will review the potential mechanisms linking obesity and cancer together with a summary of the available studies of weight control in cancer survivors. Guidelines for cancer survivors regarding diet and physical activity for risk reduction and weight control also will be discussed.

Nutrition in the Prevention and Treatment of Disease

Writing prescriptions to treat disease/illness is a primary aspect of patient care performed by physicians. However, few physicians write prescriptions for nutritional intervention, particularly to prevent disease, despite increasing evidence that dietary/nutritional intake plays a key role in the prevention and treatment of several diseases including:

Dietary Guidelines for the Elderly

The Dietary Guidelines for Americans were developed in 1990 by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (USDHHS) to provide Americans with more specific recommendations on how to eat to reduce the risk of certain chronic diseases. These guidelines are appropriate for all ages including the elderly population.

Impact of Medications on Nutritional Status in the Elderly

People 65 years and older make up approximately 13% of the U.S. population, yet they use about 30% of the country’s prescription and nonprescription drugs. Many elderly patients are on multiple medications for treatment of chronic conditions and diseases. Further complicating pharmaceutical management of elderly patients are physiological changes brought on by the aging process that affect the way the body absorbs, distributes, metabolizes, and eliminates medications.