Inhoud
Week 6 Nutrition for Specific Groups.....................................................................................................2
Week 6 Developmental psychology......................................................................................................11
Week 6 Journal Club 3..........................................................................................................................13
Week 7 Journal club 4...........................................................................................................................20
Week 8 Theory of prevention and health promotion, behavioral theories..........................................25
Week 9 Educational models, and International nutrition guidelines, tables and prevention models for
different countries................................................................................................................................34
Week 11 Nutritional Intervention Programmes, Financial Organisation of Interventions....................49
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,Week 6 Nutrition for Specific Groups
- Inzicht 2 MC
- Toepassen 2 MC
Explain the nutritional needs of humans in the adult and older adult
stages of life.
Leg de voedingsbehoeften van mensen uit in de levensfasen van volwassenen en
ouderen
Factsheet the eldery and nutrition
A healthy diet and regular exercise are important to live longer and to postpone
(uitstellen) chronic diseases and limitations (beperkingen) as long as possible
This also applies to the elderly
The elderly are a very diverse group of people
The ageing process varies from one person to another
While there are general dietary guidelines, additional, more specific
recommendations may be required
The following general recommendations are especially important for the elderly:
Energy requirement (energiebehoefte neemt af) decreases with increasing
age
o Limit the use of products with a high energy density, such as soft
drinks, alcohol and snacks
o Eat more food with a favourable nutrient density (dichtheid)
Eat plenty of fruit, vegetables, and whole-grain products each day
o These promote regular bowel movements (bevorderen een
regelmatige stoelgang) and prevent cardiovascular disease
Eat fish twice a week, including oily fish once a week
o This helps prevent cardiovascular disease and may also help to
prevent visual disorders (visuele stoornissen), and cognitive
(cognitieve achteruitgang)
Take extra vitamin D for healthy bones
Take sufficient exercise (beweeg voldoende)
Limit the amount of salt in the diet
o To prevent high blood pressure, and because kidney function is
declining
o It is also important to drink enough
Avoid foodborne infections! (voorkom door voedsel overgedragen
infecties)
What issues are involved?
One of the aims of current government policy is to enable (in staat te stellen) the
elderly to live independently for as long as possible
Good health has an important part to play here
o Healthy eating and adequate exercise are important if the elderly
are to stay physically fit
Obstacles to healthy eating It can be more difficult for elderly people to eat
healthily
The main obstacles are the diseases and limitations that may affect them
o For example, elderly people may have problems chewing and
swallowing
o They often suffer from several chronic diseases, for which they have
to take a range of medication
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, When taken alone or in combination, these medications have
adverse effects, such as dry mouth, tender or bleeding gums
or poor appetite
Medications can affect nutrient absorption
Diseases such as dementia, depression and heart failure may,
of themselves, cause elderly individuals to lose their appetite
People’s social environment (low income, poverty (armoede)
or loneliness) may cause them to eat less or to eat less well
Malnutrition
The obstacles to healthy eating are risk factors for malnutrition
It is difficult to recover from malnutrition, so it is important to identify such
risk factors in time
o The Longitudinal Aging Study Amsterdam34 estimated that 7% of
elderly people living independently, and making no use of home-
care services, are malnourished
o In the group of elderly people who do make use of home-care
services, the figure is twice as high
o In institutions, one out of every four or five elderly people is
malnourished
Overweight
Aside from malnutrition, obesity also poses (vormt) a problem
Fat percentage also increases, so – for a given body weight – elderly
people, on average, have more fat and less muscle mass
The relatonshop between energy requirement, overweight and malnutrition
As older people generally take less exercise, the amount of muscle tissue
decreases
As a result, their basal metabolic rate falls by 2% to 2.9% every 10 years
o Their energy requirement decreases with increasing age
If the amount of food eaten remains the same, this decrease can lead to the
development of overweight
It can also lead to the development of malnutrition, if the reduced
requirement results in a poor appetite)
Same amount of protein, fat and carbohydrate
For the elderly, there are no specific recommendations regarding the protein, fat,
and carbohydrate composition of the diet
At international level, however, there is a debate concerning a possible
increase in the protein level recommended for the elderly
o The Health Council of the Netherlands and the European Food Safety
Authority (EFSA) take the view that elderly people do not require
extra protein
Loss of muscle mass and muscle function
As a result of ageing, disease and reduced physical activity, there is a loss of
muscle mass and muscle function
This is called sarcopenia
o Sarcopenia is accompanied (vergezeld) by an imbalance between
the synthesis (aanmaak) and breakdown of muscle protein
As a result, there is a loss of muscle mass
This process begins sometime after the age of 30 and is progressive, such that it
increasingly causes physical problems for those aged over 70
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, To prevent sarcopenia, it is important to engage (deel te nemen aan) in
muscle-strengthening activities and to take enough protein
Focus on water
In elderly people there is a decline in kidney function
More urine is required to flush away any waste
o So elderly people need to drink more, about 1.7 litres/day
Under normal circumstances, even in extreme old age, the feeling of thirst is
sufficient to ensure that elderly people drink enough liquid
In elderly people who are less self-reliant, a stronger focus on their fluid
intake is required
The same applies to elderly people suffering from urinary incontinence and
constipation, illness, and hot summers
Checking vitamins
The Health Council of the Netherlands takes the view (is van mening) that people
over the age of 50 are not likely to be in greater need of vitamins A, E and C and
most B vitamins
Only in the case of vitamin B6 is a higher level recommended
In old age, the body absorbs less vitamin B12 from food
As a result, some elderly individuals may develop a deficiency
If someone already has a deficiency, it is almost impossible to compensate
for this by means of a normal diet
o In such cases, vitamin B12 injections will usually be administered
(toegediend)
o Another option is to take a very high dose supplement
Bij ouderen wordt vitamine B12 tekort met name veroorzaakt door
voedings-cobalamine-malabsorptie en pernicieuze anemie
o Voedings-combalamine-malabsorptie wordt gekarakteriseerd door
het onvermogen vitamine B12 uit voeding op te nemen los te
maken van eiwit, door e weinig transporteiwitten, of door beide
Oorzaken vitamine b12 te kort
Pernicieuze anemie
o Bepaalde vorm van bloedarmoede die ontstaat als gevolg van een
auto-immuunziekte van het maagslijmvlies
o Hierdoor produceert de maag niet of nauwelijks intrinsic factor
Dit stofje is belangrijk voor goede opname B12 in dunne darm
Infectie met de helicobacter pylori-bacterie
o Deze infectie kan de oorzaak zijn van atrofische maagontsteking
o Hierbij is de slijmvlieslaag aan de binnenkant van de maag veel
dunner dan normaal waardoor minder IF door de maag wordt
produceert
Verminderde inname vitamine B12
o Met name bij alcoholisten en veganisten/vegetariërs
Operatie laatste deel dunne darm
o Vitamine B12 wordt via de wand van het ilieum door het lichaam
opgenomen
Bacteriële overgroei in de dunne darm
o Minder goed opgenomen door lichaam
Maagoperatie waarbij (een groot deel) van de maag verwijderd wordt
o Geen IF meer
Medicijngebruik
Verminderde maagzuurproductie
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