CHAPTER 16 NUTRITION DURING ADULTHOOD OVERVIEW This chapter begins by encouraging adults to follow the advice of MyPyramid and the Dietary Guidelines. The four stages of adulthood, life span, and life expectancy are defined. The Graying of America and the nutrition-related issues surrounding it are presented as a growing concern. Theories of aging are briefly discussed. Physiological changes that affect nutrient intake, absorption, and metabolism are described; suggestions are given for helping elderly adults achieve good nutritional status. Other factors, such as medications, alternative medicine, depression, and their roles in maintaining good nutritional status are discussed. A section on community nutrition services for older people focuses on the role of the federal government in promoting the health of older adults. The Nutrition and Your Health section explores the nutrition implications of alcohol consumption. KEY TERMS Acetaldehyde dehydrogenase Aging Alcohol use disorder Alcohol dehydrogenase Alcohol dependence Alcoholism Binge drinking Cirrhosis Compression of morbidity Endometrium Ethanol Glycosylation Heavy drinking Hospice care Kidney nephrons Life expectancy Life span Menopause Moderate drinking Ostomy Reserve capacity Sarcopenia Sarcopenic obesity Thrifty metabolism Tolerance Withdrawal STUDENT LEARNING OUTCOMES Chapter 16 is designed to allow you to: 16.1 Discuss demographic trends among adults in North America and how they impact health care. 16.2 List several hypotheses about the causes of aging. 16.3 Describe how physiological changes of aging affect nutritional status of adults. 16.4 Describe how psychosocial changes of aging affect nutritional status of adults. 16.5 Compare the dietary intake of adults with current recommendations. 16.6 Identify nutrition-related health conditions of the adult years and describe the prevention and treatment options. 16.7 List several nutritional programs available to help meet nutritional needs of older adults. 16.8 Compare benefits of moderate alcohol use to risks of alcohol abuse. LECTURE OUTLINE 16.1 The Graying of North America A. Overview 1. Advances in health care and sanitation allow population to live longer a. 85+ is fastest growing age group (see Fig. 16-1) b. By 2050, 1 million+ people will be >100 years old 2. Challenges for health care system a. High use of prescription medications b. High rate of acute hospital stays c. 50% of federal health budget d. 80% of older adults has one or more nutrition-related health problems 1) Heart problems 2) Type 2 diabetes 3) Hypertension 4) Osteoporosis 3. Aging is not a disease; many chronic diseases can be prevented or managed B. The Causes of Aging 1. Aging: time-dependent physical and physiological changes in body structure and function that occur normally and progressively throughout adulthood as humans mature and become older 2. Process of slow cell death begins soon after fertilization a. Able to endure this cell death because of reserve capacity of organs and organ systems b. After age 30, rate of cell breakdown begins to exceed rate of cell renewal, leading to gradual decline in organ size and efficiency c. Example: alcohol intake overtaxes aging liver 3. Hypotheses about the causes of aging (see Table 16-1) a. Errors in DNA replication b. Stiffening connective tissue c. Oxidative damage d. Hormone function changes e. Glycosylation of proteins f. Loss of immune system efficiency g. Development of autoimmunity h. Programmed cell death i. Excess calorie intake speeds body breakdown 4. Aging is likely due to a combination of genetics, lifestyle practices, and environment C. Usual and Successful Aging 1. Usual aging: changes commonly thought to be expected parts of aging, but actually due to lifestyle choices, environmental exposures, and chronic disease (e.g., increasing body fatness, decreasing lean mass, hypertension, decreasing bone mass, worsened health) 2. Successful aging: declines in physical and physiological function that occur only because one grows older; not due to lifestyle choices, environmental exposures, and chronic disease 3. Compression of morbidity: delay the onset of disabilities caused by chronic disease to enjoy greatest number of healthy years and fewest years of illness D. Factors Affecting the Rate of Aging 1. Life span a. Maximal number of years humans live b. 122 years (woman) or 114 years (man) is the longest a human has lived 2. Life expectancy a. The time an average person born in a specific year can expect to live b. Men: 75 years c. Women: 80 years 3. Rate of aging in individual is determined by heredity, lifestyle, and environment. 4. Heredity a. Genes influence longevity b. Gender: women typically live longer than men c. Metabolic efficiency 1) Throughout history, those with thrifty metabolism survived through periods of scarce food 2) In today’s environment, thrifty metabolism may reduce longevity 5. Lifestyle a. Pattern of living including food choices, exercise, and substance use b. Affects expression of genetic potential c. Highest life expectancy is in Okinawa (86 y for women; 78 y for men) 1) Diet based on rice, fish, vegetable protein, fruits, vegetables, tea, herbs, small amounts of meat; low intake of alcohol and salt 2) Low average BMI (21 kg/m2) d. Mediterranean Diet 1) Olive oil is main dietary fat 2) Abundant intake of fruits, vegetables, whole grains, beans, nuts, and seeds 3) Minimally processed, seasonally fresh, locally grown foods 4) Minimal daily intake of cheese and yogurt 5) Weekly intake of fish 6) Limited use of eggs and red meat 7) Regular exercise 8) Moderate wine consumption with meals 6. Environment a. Income b. Education level c. Health care d. Shelter e. Psychosocial factors 1) Autonomy 2) Informational and emotional resources 16.2 Nutrient Needs During Adulthood A. Overview 1. 2010 Dietary Guidelines for Americans a. Balance calories with physical activity to manage weight b. Consume more fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood c. Consume fewer foods with sodium, saturated fats, trans fats, cholesterol, added sugar, and refined grains 2. Maintain healthy body weight 3. Safe food handling 4. Benefits of adequate nutrition a. Delays onset of some diseases b. Improves management of existing diseases c. Speeds recovery from illness d. Increases mental, physical, and social well-being e. Decreases need for/length of hospitalization 5. Common dietary excesses among adults a. Calories b. Fat c. Sodium d. Alcohol 6. Common dietary shortfalls among adults a. Vitamin D b. Vitamin E c. Folate d. Magnesium e. Calcium f. Zinc g. Fiber h. Iron (for premenopausal women) 7. Adults age 65+ are at highest risk of malnutrition, particularly in long-term care facilities 8. Nutrition checklist for older adults (see Figure 16-3) B. Calories 1. Calorie needs decrease throughout adulthood after age 30 due to gradual decline in basal metabolism (2% decline in metabolism per decade) 2. Exercise can counteract decline in calorie needs C. Protein 1. Consuming slightly more than RDA may help preserve bone and muscle mass among older adults 2. Deficiency most likely among those who have limited income, chewing or swallowing difficulties, or lactose intolerance 3. Excessive protein intake may accelerate decline in kidney function D. Fat 1. Strong link between high fat intake, obesity, heart disease, and certain cancers 2. Focus on nutrient density rather than energy density E. Carbohydrates 1. Overall intake is lower than recommendations 2. Most adults would benefit from substituting complex carbohydrates for simple carbohydrates 3. >25% of adults older than age 65 have diabetes 4. Increasing fiber intake would a. Reduce risk for colon cancer b. Reduce risk for heart disease c. Lower blood cholesterol d. Improve bowel regularity F. Water 1. Many adults are in constant state of mild dehydration 2. Mild dehydration may be due to a. Loss of thirst sensation b. Chronic diseases c. Conscious reduction in intake to reduce frequency of urination d. Diuretic medications e. Ostomy f. Age-related decline in kidneys’ ability to concentrate urine 3. Symptoms of dehydration a. Disorientation and mental confusion b. Constipation c. Bowel impaction d. Death G. Minerals and vitamins 1. Relative nutrient requirements for older men and women are presented in Figures 16-4 and 16-5 2. Many older adults would benefit from balanced daily multivitamin and mineral supplement 3. Calcium and vitamin D a. Intake low in adults b. Reduced absorption c. Calcium 1) Bioavailable food sources may be limited in cases of lactose intolerance 2) Focus on low-fat milk products (if possible), calcium-fortified foods, fish eaten with bones, and dark green leafy vegetables d. Vitamin D 1) Reduced synthesis in skin 2) Reduced ability of kidneys to convert prohormone to its active form 3) Food sources are limited 4) 10–15 minutes per day of sunlight can improve vitamin D status 4. Iron a. Iron-deficiency anemia is most common type of malnutrition during adult years b. Menstrual losses lead to iron deficiency in women c. GI bleeding (e.g., due to ulcers, hemorrhoids, or aspirin use) d. Impaired iron absorption due to low stomach acid production 5. Zinc a. Poor intake b. Absorption declines as stomach acid production decreases c. Consequences 1) Loss of taste sensation 2) Mental lethargy 3) Delayed wound healing 6. Magnesium a. Inadequate intake b. Consequences 1) Loss of bone strength; osteoporosis 2) Muscular weakness 3) Mental confusion 4) Heart rhythm abnormalities 5) Cardiovascular disease 6) Diabetes c. Food sources are best; supplemental sources may cause loose stools 7. Sodium a. Average intake—3400 mg per day b. Increased intake of processed foods and eating out c. Preference for increased salt as sense of taste declines d. Dietary Guidelines recommend limiting sodium to 2300 mg per day (1500 mg per day if existing hypertension, pre-hypertension, diabetes, or kidney disease, African American) e. Excess sodium leads to hypertension f. Hyponatremia can occur, especially if taking diuretics or with poor kidney function 8. Folate and vitamin B-6 and B-12 a. Folate important for women during childbearing years due to risk for neural tube defects b. Folate, vitamin B-6 and B-12 required for metabolism of homocysteine, which is associated with increased risk of cardiovascular disease, stroke, bone fracture, and neurological decline c. Vitamin B-12 intake should increase after 50 due to decreased absorption 1) Low stomach acid production 2) Low intrinsic factor d. Vitamin B-12 supplements or fortified foods are needed by adults over age 50 9. Vitamin E a. Most adults do not consume enough b. Maintains antioxidant functions 10. Carotenoids a. Lutein and zeaxanthin linked to prevention of cataracts and age-related macular degeneration b. Diets high in fruits and vegetables are protective against many age-related conditions H. Are Adults Following Current Dietary Recommendations? 1. Positive trends since 1950s show increased unsaturated fat, decreased saturated fat consumption 2. Negative trends: major kilocalorie contributors include a. White bread b. Beef, chicken c. Doughnuts, cakes, cookies d. Soft drinks e. Salad dressing, mayonnaise, margarine f. Milk, cheese g. Potatoes h. Sugars, syrups, jams 16.3 Physiological Factors Related to Nutritional Status of Adults A. Overview 1. Aging body loses resilience; less able to handle stressors and restore homeostasis 2. Kidneys take longer to remove wastes 3. Liver takes longer to metabolize alcohol, drugs, and supplements 4. Avoid stressing the body’s capabilities 5. Physiological changes of aging that affect nutrition status (Table 16-2) B. Body Composition 1. Common changes a. Diminished lean mass (sarcopenia) leads to reduced basal metabolism, muscle strength, and energy needs b. Increased fat stores (sarcopenic obesity) c. Decreased body water 2. Unintended decreases in body weight a. 2% adults over 70 are underweight b. Increased risk of nutrition-related illness and death c. Causes of unintended weight loss 1) Illness 2) Depression/social isolation 3) Side effects of medications 4) Changes in taste or smell 5) Reduced chewing ability 6) Limited financial resources 7) Decreased dexterity or strength C. Bones and Joints 1. Bone loss for men (slow and steady after middle age) and women (dramatically after menopause) 2. Many undiagnosed cases of osteomalacia (insufficient vitamin D) 3. Osteoporosis limits mobility and independence 4. Strategies to preserve bone mass a. Adequate vitamin D b. Adequate calcium c. Adequate protein d. Avoid smoking e. Moderate alcohol consumption f. Medications 5. Osteoarthritis increases in prevalence with advancing age and is the leading cause of disability among older persons 6. Glucosamine and/or chondroitin can relieve pain, slow progression of joint degeneration, or rebuild cartilage D. Exercise 1. Benefits a. Increases muscle strength and mobility b. Improves balance; decreases risk of falls c. Improves ability to complete activities of daily living d. Improves sleep e. Slows bone loss f. Increases joint movement g. Improves mental outlook h. Maintains basal metabolic rate 2. Aerobic exercise a. All adults should engage in moderate-intensity aerobic exercise for at least 150 minutes per week, vigorous-intensity aerobic exercise for 75 minutes per week or an equivalent combination of the two. b. Increase pace gradually if newly physically active 3. Strength training a. Strength training can help maintain lean tissue and basal metabolic rate b. 2 to 3 times per week c. Emphasize large muscle groups 4. Flexibility exercises a. Stretching should accompany all exercise b. Makes daily tasks easier E. Digestive System 1. 25% older adults have no natural teeth, which can affect chewing ability and thus nutrition 2. Decreased production of stomach acid, intrinsic factor, and lactase impairs absorption of several nutrients 3. Constipation a. Increase fiber b. Increase fluids c. Exercise d. Fiber supplements, stool softeners, or laxatives in some cases 4. Less efficient liver function a. Impairs ability to metabolize some nutrients; increased risk for toxicity b. Detoxification systems (e.g., alcohol) reduced 5. Gallbladder malfunctions impair fat digestion 6. Pancreatic function declines F. Nervous System 1. Decreased senses of taste and smell reduce appetite 2. Decline in mental ability, coordination, hearing, and eyesight may result in decreased social interaction, thus increasing risk of poor dietary intake 3. Declining eyesight and neuromuscular coordination impairs ability to shop for, prepare, and consume food 4. Diet rich in fruits and vegetables provides carotenoids, which reduce risk of macular degeneration and cataracts G. Immune System 1. Undernutrition impairs immune function a. Protein b. Folate c. Vitamin A d. Vitamin D e. Vitamin E f. Iron g. Zinc 2. Overnutrition may also impair immune system a. Obesity b. Dietary fat c. Iron d. Zinc H. Endocrine System 1. Decreased insulin production 2. Insulin resistance I. Chronic Disease 1. 80% of older adults suffer from one or more chronic diseases 2. Impaired mobility affects ability to shop for and prepare food 3. Altered nutrient needs a. Cancer increases calorie and nutrient needs b. Hypertension may necessitate sodium restriction 4. Altered nutrient utilization a. Diabetes impairs glucose uptake b. With heart disease, kidneys’ ability to reabsorb glucose, amino acids, and vitamin C declines J. Medications 1. 90% of older adults take at least one prescription medication daily 2. Half of all adults older than age 65 take several medicines each day 3. Half of adults older than age 50 use supplements 4. With aging, effects of medications and supplements are exaggerated and prolonged 5. Medications may adversely impact nutritional status a. Loss of taste or smell b. Induce anorexia or nausea c. Aspirin may induce GI bleeding, which increases iron needs d. Antibiotics deplete vitamin K (produced by microflora) e. Diuretics or laxatives increase excretion of water and some minerals f. Interactions among supplemented nutrients g. Interactions between medications and nutrients 6. Consume nutrient-dense foods and avoid any specific food or supplement that interferes with the function of their medications. K. Complementary and Alternative Medicine 1. Herbs are not evaluated by the FDA for effectiveness or safety 2. A rational approach to herb use a. Take one at a time b. Keep a journal of symptoms c. Check with physician before discontinuing medications d. Contact physician to report adverse effects 3. Table 16-3 summarizes popular herbal remedies 16.4 Psychosocial Factors Related to Nutritional Status of Adults A. Overview 1. Deteriorating physical abilities may cause social withdrawal, which usually leads to poor food intake 2. Nutrition assistance programs can help older people obtain the food and social support needed for good health. B. Depression 1. Major depression affects 11% men and 16% women over the age of 65. 2. Contributes to poor appetite, malnutrition, weight loss, weakness, mental confusion, social isolation (see Fig. 16-6) 3. Some people cope with depression by overeating 4. May impair recovery from illness or injury 5. 15% of cases of depression result in suicide 6. Early detection, treatment, and social support are important 7. Depression has been linked to poor intakes of omega-3 fatty acids, vitamin D, and some B vitamins. C. Alzheimer’s Disease 1. Irreversible, abnormal, progressive deterioration of brain that causes loss of memory, reasoning, and comprehension 2. Affects 5.1 million adults in U.S. 3. Possible causes a. Alterations in cell development or protein production in the brain b. Strokes c. Altered blood lipoprotein composition d. Obesity e. Poor glucose regulation f. Hypertension g. High cholesterol h. Oxidative damage 4. Disease process beings 10–20 years before warning signs appear 5. Warning signs a. Memory loss b. Difficulty performing familiar tasks c. Problems with language d. Disorientation to time and place e. Faulty or decreased judgment f. Problems with abstract thinking g. Tendency to misplace things h. Changes in mood or behavior i. Changes in personality j. Loss of initiative 6. Postulated preventive measures a. Lifelong learning b. Fruits and vegetables c. Ibuprofen d. Antioxidant nutrients (e.g., vitamin C, vitamin E, selenium) e. Regulate blood homocysteine (e.g., folate, vitamin B-6, and vitamin B-12) f. Emphasize omega-3 and omega-6 fats; limit saturated and trans fats g. Regular physical activity 7. Caregivers should ensure nutritional adequacy and physical activity of those with Alzheimer's disease. D. Economic Factors 1. Amount of money to purchase foods impacts diet quality and quantity 2. Federal food assistance programs a. Commodity Supplemental Food Program b. Supplemental Nutrition Assistance Program (SNAP) 16.5 Ensuring a Healthful Diet for the Adult Years A. Overview 1. General dietary recommendations a. Increase nutrient density b. Ensure adequate fiber and fluid intake c. Lean meats provide protein, vitamin B-6, vitamin B-12, iron, and zinc 2. Logistical problems to overcome a. Purchasing, preparing, storing, and using food with minimal waste b. Living without kitchens and freezers c. Limited budget 3. Practical suggestions a. Freeze single size portions b. Buy small packages, as spoilage is costly c. Ask grocer to package smaller portions of meat d. Buy produce of varied ripeness e. Keep dry milk on hand to add nutritional value where possible 4. Table 16-4 provide guidelines for healthy eating in later years 5. Protein-calorie malnutrition is common, especially in nursing facilities a. Decreased ability to recover from illness b. Bed sores c. Families must observe weight and eating habits 6. Benefits of good nutrition for older adults a. Delays onset of some diseases b. Improves management of existing diseases c. Hastens recovery from illness d. Increases mental, physical, and social well-being e. Decreases need for and length of hospitalization 7. Older adults should use MyPlate as a guide to healthy meals 8. Daily Food Plans are available at ChooseMyPlate.gov and are based on an individual’s age, weight, height, gender, and activity level 9. Older adults should focus on the following a. Nutrient density b. Plenty of fluids c. Modified physical activity goals d. Use of certain dietary supplements 10. Social support of friends and family is important for meeting nutritional needs because some older adults may not ask for much-needed help B. Community Nutrition Services for Older People 1. The Older Americans Act Nutrition Program a. Serves meals to adults over age of 60 in U.S. b. Meals must supply at least 1/3 of adult energy and nutrient requirements. 1) Meals-on-Wheels 2) Congregate feeding centers 3) Federal commodity distribution c. SNAP d. Food cooperatives, clubs, and religious and social organizations Nutrition and Your Health: Nutrition Implications of Alcohol Consumption A. Overview 1. Ethanol: form of alcohol found in alcoholic beverages 2. Contributes ~7 kcal/g 3. Constitutes 3% of total calories for North American adults (see Table 16-5) 4. Moderate drinking a. No more than 4 drinks in one day AND no more than 14 drinks per week for men b. No more than 3 drinks in one day AND no more than 7 drinks per week 5. Binge-drinking—drinking so much within a short time (usually 2 hours) that blood alcohol concentration rises above the legal limit of 0.08 g/dl 6. Although it has some health benefits when used in moderation, alcohol is the most commonly abused drug 7. Standard drink sizes are depicted in Figure 16-7. B. How Alcoholic Beverages Are Produced 1. Fermentation of simple sugars by microorganisms produces alcohol, carbon dioxide, and water 2. Production temperatures, food sources, and aging techniques contribute to final product a. Wine: grapes and other fruits b. Beer: malted cereal grain c. Distilled spirits: fruits, vegetables, grains C. Absorption and Metabolism of Alcohol 1. Alcohol is not digested; it is efficiently absorbed by diffusion 2. Liver is primary site for alcohol metabolism (stomach cells are also involved to a minor extent) a. Alcohol dehydrogenase b. Acetaldehyde dehydrogenase 3. As consumption exceeds metabolism, signs of intoxication appear (see Table 16-5) 4. Women are affected by alcohol differently than men a. Extent of alcohol metabolism in stomach cells b. Amount of body water c. Development of alcohol-related ailments D. Benefits of Moderate Alcohol Use (see Table 16-7) 1. Two drinks/day for men; one drink/day for women and older adults 2. Socialization and relaxation 3. Lower risk of cardiovascular disease and type 2 diabetes E. Risks of Heavy Drinking 1. Alcohol use disorder a. Use of alcohol in larger amounts or over a longer period than intended b. Persistent desire or unsuccessful efforts at cutting down or controlling alcohol use c. Spending a great deal of time obtaining, using, and recovering from the effects of alcohol d. Experiencing cravings for alcohol e. Repeated use of alcohol that results in failure to fulfill major obligations at school, work, or home f. Continued use of alcohol despite interpersonal problems created by the effects of heavy drinking g. Giving up important social, occupational, or recreational activities due to use of alcohol h. Recurrent alcohol use in situations in which it is physically hazardous i. Continuing to use alcohol even after realizing one has a problem caused by heavy drinking j. Developing a tolerance to the effects of alcohol k. Experiencing symptoms of withdrawal in the absence of alcohol use 2. Alcohol abuse disorders affect 17% of adult men and 8% women 3. Genetic risk 4. Early diagnosis of alcoholism can prevent health problems and save in health care costs a. CAGE Questionnaire b. General criteria 1) Physiologic dependence; evidence of withdrawal 2) Tolerance 3) Alcohol-associated illnesses 4) Continued drinking despite medical and social contraindications 5) Depression, blackouts, and impaired function c. Observable signs 1) Alcohol odor on the breath 2) Flushed face; reddened skin 3) Nervous system disorders (e.g., tremors) 4) Unexplained work absences 5) Frequent accidents, falls, or injuries of vague origin 6) Laboratory evidence (e.g., liver function, enlarged RBCs, elevated triglycerides) 5. Other risks of heavy drinking a. Heart failure b. Cancer c. Cirrhosis develops in 20% of cases of alcoholism d. Motor vehicle accidents e. Suicides f. Nutrient deficiencies associated with alcohol abuse are due to poor nutrient intake, increased urinary losses, and fat malabsorption 1) Fat-soluble vitamins (A, D, E, and K) 2) Water-soluble vitamins (thiamin, niacin, folate, vitamin B-6, vitamin B-12, and vitamin C) 3) Mineral deficiencies (calcium, phosphorus, potassium, magnesium, zinc, and iron) g. There may also be risk of certain nutrient toxicities (vitamin A, iron, lead, or cobalt) 6. Older adults are particularly susceptible to alcoholism a. Abundance of free time b. Social events c. Loneliness d. Depression e. Symptoms of alcoholism are often mistaken for signs of aging f. Slower alcohol metabolism g. Medication interactions 7. Treatment a. Medications b. Counseling (individual and family) c. Social support (Alcoholic Anonymous) F. Guidance Regarding Alcohol Use 1. The 2010 Dietary Guidelines for Americans provides advice related to consumption of alcoholic beverages a. Moderation b. The following individuals should avoid alcohol 1) Those who cannot restrict alcohol intake 2) Women of childbearing age who may become pregnant 3) Pregnant and lactating women 4) Children and adolescents 5) Those taking medications that interact with alcohol 6) Those with medical conditions for which alcohol use is contraindicated 7) Those engaging in activities that require attention, skill, or coordination c. For weight management, one should monitor caloric intake from alcoholic beverages. BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE 1. Assign students the Rate Your Plate activity, Part II. It is a case study of an elderly person with nutritional status and outlook problems. Have them bring it to class completed and use it as a springboard for class discussion about helping elderly people achieve good nutritional status. 2. Ask a nutrition professional from the local branch of the Federal Office of Aging to give a guest lecture in your class about the problem of nutrition and aging. 3. If possible, plan for students to visit an elderly feeding program and join the seniors for lunch. Ask them to share their observations of nutritional quality of the diet, and acceptance of the meal by the participants and other activities associated with the meal program. Many such programs welcome guests and eagerly seek volunteers. 4. Ask students to plan a menu for one day for a man and woman who are 70 years of age. It should meet their nutritional needs and the midpoint of the RDA range for kcalories for their age. 5. Assign students the Real Age test on the www.realage.com website. Have them bring their results to class. Discuss the lifestyle and nutritional recommendations offered by the site. Ask whether the students checked out the site’s Scientific Advisory Board to determine the qualifications of those providing the recommendations. 6. For those students who were assigned a diet analysis project at the beginning of the course, ask them to complete a new diet analysis. Have them write a paper on the nutritional knowledge they have gained since the start of the course and how they have implemented it in their lives. What changes have they made during the term? What has been the impact on their food choices and meeting their nutritional goals? 7. Divide the class into groups and assign a disease to each group. Based upon their research, have each group design a screening questionnaire for that disease. Have the students present their list of questions and their rationale for choosing them. 8. Using diet analysis software, have students create a food list called “One Perfect Day.” Ask them to use their own food preferences to create a single day diet that most closely fulfills their personal RDAs. Instructor Manual for Wardlaw's Contemporary Nutrition Anne M. Smith , Angela L. Collene 9780078021374, 9781260092189
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