DEPARTMENT OF PROSTHODONTICS

Presented By: Dr. SARYU BAWA (M.D.S- Ist Year)

DIET AND NUTRITION

CONTENTSCONTENTSINTRODUCTION

NUTRITIONAL OBJECTIVES

NUTRIENT CONTENT CLAIMS

AGING FACTORS THAT AFFECT NUTRITIONAL STATUS

ORAL FACTORS THAT AFFECT DIET AND NUTRITIONAL STATUS

ASSESSING NUTRITIONAL STATUS

FOODS RECOMMENDED FOR THE ELDERLY

DIET RECOMMENDED FOR NEW DENTURE WEARER

NUTRITION COUNSELING AND DIETARY GUIDANCE

SUMMARY

INTRODUCTIONINTRODUCTIONNutrition might influence the occurrence and severity

of degenerative diseases.Nutrition provides substrates essential for expression

of genetic heritage.Geriatric nutrition applies nutrition principles to delay

effects of aging and disease, to aid in the management of the physical, psychological, and psychosocial changes commonly associated with growing old.

Proper nutrition is essential to the health and comfort of oral tissues and healthy tissues enhance the possibility of successful Prosthodontic treatment in the elderly.

NUTRITIONAL OBJECTIVESNUTRITIONAL OBJECTIVES

To establish a balanced diet which is consistent with the physical, social, psychological and economic background of the patient.

To provide temporary dietary supportive treatment, directed towards specific goals such as caries control, postoperative healing, or soft tissue conditioning.

To interpret factors peculiar to the denture age group of patients, which may relate to or complicate nutritional therapy.

Nutrient Content ClaimsNutrient Content Claims

Free-- "calorie-free" means fewer than 5 calories per serving, and "sugar-free" and "fat-free" both mean less than 0.5 g per serving. E.g: skim milk.

LOWlow-fat: 3 g or less per serving low-saturated fat: 1 g or less per serving low-sodium: 140 mg or less per serving very low sodium: 35 mg or less per serving low-cholesterol: 20 mg or less and 2 g or less of saturated fat per serving low-calorie: 40 calories or less per serving.

Lean: less than 10 g fat, 4.5 g or less saturated fat, and less than 95 mg cholesterol per serving as per 100 g.Extra Lean: less than 5 g fat, less than 2 g saturated fat, and less than 95 mg cholesterol per serving as per 100 g.

High. This term can be used if the food contains 20 percent or more of the Daily Value for a particular nutrient in a serving. Good source. This term means that one serving of a food contains 10 to 19 percent of the Daily Value for a particular nutrient. Reduced. This term means that a nutritionally altered product contains at least 25 percent less of a nutrient or of calories than the regular, or reference, product. Less. This term means that a food, whether altered or not, contains 25 percent less of a nutrient or of calories than the reference food. For example, pretzels that have 25 percent less fat than potato chips could carry a "less" claim.

Nutrient Content ClaimsNutrient Content Claims

Light. This descriptor can mean two things: First, that a nutritionally altered product contains one-third fewer calories or half the fat of the reference food. If the food derives 50 percent or more of its calories from fat, the reduction must be 50 percent of the fat. Second, that the sodium content of a low-calorie, low-fat food has been reduced by 50 percent.

More: that a serving of food, whether altered or not, contains a nutrient that is at least 10 percent of the Daily Value more than the reference food. The 10 percent of Daily Value also applies to "fortified," "enriched" and "added" "extra and plus" claims, but in those cases, the food must be altered.

Nutrient Content Claims

Healthy. A "healthy" food must be low in fat and saturated fat and contain limited amounts of cholesterol and sodium. In addition, if it’s a single-item food, it must provide at least 10 percent of one or more of vitamins A or C, iron, calcium, protein, or fiber.

Meals and main dishes Standardized foods

Nutrient Content Claims

AGING FACTORS THAT AGING FACTORS THAT AFFECT NUTRITIONAL AFFECT NUTRITIONAL

STATUSSTATUS "young old" (65 to 75)"young old" (65 to 75)

"old old" (75 to 85) and"old old" (75 to 85) and

"oldest old" (85 and beyond)"oldest old" (85 and beyond)

Physiological FactorsPhysiological Factors With a decline in lean body mass in the elderly, caloric needs decrease and

risk of falling increases.

Vitamin D deficiency in turn, is a major cause of metabolic bone disease in the elderly.

Declines in gastric acidity often occur with age and can cause malabsorption of food-bound vitamin B12.

Many nutrient deficiencies common in the elderly, including zinc and vitamin B6, seem to result in decreased or modified immune responses.

Dehydration, caused by declines in kidney function and total body water metabolism, is a major concern in the older population.

Over deficiency of several vitamins is associated with neurological and/or behavioral impairment B1 (thiamin), B2, niacin, B6 [pyridoxine], B12, foliate, pantothenic acid, vitamin C and vitamin E).

Physiological FactorsPhysiological Factors

A host of life-situational factors increase nutritional risk in elders.

Elders, particularly at risk, include living alone physically handicapped with insufficient care isolated with chronic disease and/or restrictive diets reduced economic status and the oldest old

Functional Factors

Functional disabilities such as arthritis, stroke, vision, or hearing impairment, can affect nutritional status indirectly.

Pharmacological Factors

• Most elders take several prescription and over-the-counter medications daily.

• Causes of anorexia, nausea, vomiting, gastrointestinal disturbances, xerostomia, taste loss and interference with nutrient absorption and utilization. These conditions can lead to nutrient deficiencies, weight loss and ultimate malnutrition.

ORAL FACTORS THAT AFFECT DIET AND

NUTRITIONAL STATUSXerostomia Sense of taste and smellDentate statusEffects of dentures on taste and

swallowingEffects of dentures on chewing abilityEffect of dentures on food choices, diet

quality and general healths

ORAL FACTORS THAT AFFECT DIET AND

NUTRITIONAL STATUSEffects of dentures on taste and swallowing•full upper denture can have an impact on taste and swallowing ability. •swallowing can be poorly coordinated and dentures can become a major contributing factor for swallowing.

Effects of dentures on chewing ability•As adults age, they tend to use more strokes and chew longer, to prepare food for swallowing.

•Masticatory efficiency in complete denture wearers is approximately 80% lower than in people with intact natural dentition.

ORAL FACTORS THAT AFFECT DIET AND

NUTRITIONAL STATUS Effect of dentures on food choices, diet quality and general

health Some people compensate for decline in masticatory ability by

choosing processed or cooked foods rather than fresh food and by chewing longer before swallowing.

Others may eliminate entire food groups from their diets.Dentate adults tend to eat more fruits and vegetables than full-

denture wearers.Replacing ill-fitting dentures with new ones does not

necessarily result in significant improvements in dietary intake.Similarly, exchanging optimal complete dentures for implant-

supported dentures, has not resulted in significant improvement in food selection or nutrient intake.

ORAL FACTORS THAT AFFECT DIET AND

NUTRITIONAL STATUSSkin integrity

Skin breakdown is a common problem, particularly in bedridden or immunologically impaired people.

The most common skin breakdown is the pressure ulcer, which occurs in 4% to 30% of hospitalized patients and 2% to 23% of residents of skilled-care nursing homes.

Pressure ulcers are graded or staged to classify the degree of tissue damage. Those with more serious Stage II to Stage IV ulcers have increased nutritional needs.

Protein needs increase to 1–1.5 gm protein/kg, caloric needs increase to 30–35 kcal/kg, and 25–35 cc fluid/kg is recommended.

NUTRIENTS NEED OF ELDERLY

ENERGY: Energy needs decline wirh age due to

decrease in basal metabolism and decreased physical activity. 1300 Kcal for women 1800 Kcal for men

Calories: RDA Value 1600 Kcal for women 2400 Kcal for men

S.No Nutrients RDA – value Physical Signs In Deficiency Source

1. Protein 56 gms for Males46gms for Females.

EdemaDull – dry – sparse – easilyplucked hairsParotid gland enlargementMuscle wasting

Diary ProductsPoultry meats

& fishNuts, GrainsVegetables

2. Carbohydrates 50 – 60 % of totalcalorie intake

Weak body Grains and Cereals

FruitsDairy products

3. Water 30 ml per kg bodyweight

DehydrationHypertensionElevated body temperatureDryness of MucosaDecreased urine output

4. Vit. A 800 – 100micrograms

Bitot’s spotsConjuctiva and Corneal xerosisXerosis of SkinFollicular hyper keratosisGeneralised gingivitisDecreased taste acuity

Dairy productsCarrots Spinach

5. Thiamine 1 mg Beri - BeriMental confusionIrritabilitySensory lossesLoss of ankle & Knee JerkCalf muscle tendernessCardiac Enlargement

MeatsWhole grainsCerealsYeast

6. Pyriodoxine 1.2 – 1.4 mg Nasolabial seborrheaGlossitis

7. Riboflavin 3.0 micrograms Nasolabial seborrheaFissuring and redness ofeyelid, corners of mouthMagenta colored tongueGenital dermatotis

MilkEggsLiverGreen leafyvegetables

8. Vit. C 60 micrograms Spongy bleeding gumsPetechiaeDelayed healing tissuesPainful Joints

Citrus fruitsTomatoesLeafy vegetables

9. Vit. D 5 micrograms Bow legsBeading of ribs

Sun lightFish liver oil

10. FolicAcid

500micrograms

GlossitisMouth ulcersMegaloblastic memiaGlossodyniaStomatitis

Green leafy vegetables,

OrangesLiverYeast

11. Calcium 800 mg Bone lossOsteoporosis

Milk & milk products

Dried beansPeasLeafy green

vegetables12. Iron 10 mg Pallor

Pale, atrophic, burningtongueSpoon nailsConjunctivitis

Meat, fish, poultryWhole grainsCerealsGreen leafy

vegetablesPeas

13. Zinc 15 mg Decreased taste acuityMental lethargySlow wound healing

Animal productsWhole grainsDried beans

Glossitis of tongue due to vit. B12 deficiency

Aphthous Ulcers due to Folic Acid

deficiency

Angular chelitis due to Riboflavin deficiency

MODIFIED FOOD PYRAMIDMODIFIED FOOD PYRAMID

Assessing Nutritional Assessing Nutritional StatusStatus

Triphasic Nutritional AnalysisTriphasic Nutritional AnalysisPhase –I

Qualitative Dietary Assessment

to determine what an individual is eating now, what he or she has eaten in the past and recent changes in the diet.

A questionnaire has been developed to identify older individuals with nutritional problems.

Semiquantitative Dietary Analysis Phase-II Phase-II

A Semiquantitative Dietary Analysis Routine blood chemistry should be

undertaken. Nutrients in all foods and beverages

consumed during a 3- to 5-day period, are calculated.

Average caloric and nutrient intakes can be quantitated and compared with norms.

Semiquantitative Dietary Analysis Phase-II Phase-II

Biochemical Assessment

most indices fall within standard ranges for young adults and

many of the parameters are affected by an age-related decline in renal function and body water, as well as the effects of drugs and chronic disease.

Semiquantitative Dietary Analysis Phase-II Phase-II

NORMAL LABORATORY VALUES IN THE ELDERLY

Protein status: albumin 4 to 6 gm/dL; prelabumin: 19 to 43 mg/dL.

Anemia status: hemoglobin: 12 to 18 gm/dL; hematocrit 33% to 49% (can be slightly lower in the elderly); MCV: 80 to 95 [.mu]m3; MCHC: 27 to 31 pg; B12: 100 to 1,300 pg/mL.

Hydration: serum sodium: 135 to 147mEq/L; serum osmolality: 285 to 295 mOsm/kg; (can be slightly higher in elderly).

Phase IIIPhase III

The Final Phase of the analysis is reserved for more complex nutritional problems and should be accomplished under the direction of a physician.

The analysis in this phase includes comprehensive nutritional biochemical assays of blood, urine and tissues, as well as tests of metabolic and endocrine function.

FOODS RECOMMENDED FOR THE FOODS RECOMMENDED FOR THE ELDERLYELDERLY

1. Four servings of vegetables and fruits, subdivided into 3 categories:

a. 2 servings of good sources of vitamin C, such as citrus fruits, salad greens and raw cabbage.

b. 1 serving of a good source of provitamin A such as deep green and yellow vegetables or fruits.

c. 1 serving of potatoes and other vegetables and fruits.

FOODS RECOMMENDED FOR FOODS RECOMMENDED FOR THE ELDERLYTHE ELDERLY

2. Four servings of enriched breads, cereals and flour products.

3. Two servings of milk and milk-based foods, such as cheese.

4. Two servings of meats, fish, poultry, eggs, dried beans, peas, nuts.

5. Additional miscellaneous foods including fats, oils and sugars, as well as alcohol; the only serving recommendation is for about 2-4 tablespoons of polyunsaturated fats, which supply essential fatty acids.

DIET RECOMMENDED FOR NEW DIET RECOMMENDED FOR NEW DENTURE WEARERDENTURE WEARER

First post-insertion dayFirst post-insertion day• Vegetable-Fruit group: Vegetable-Fruit group: Juices

• Bread-Cereal group: Bread-Cereal group: Gruels cooked in either milk or water.

• Milk group: Milk group: Fluid milk may be taken in any form..

• Meat group: Meat group: Eggs in eggnogs, pureed meats, meat broths, or soups.

• The sample menu should contain a glass of milk at The sample menu should contain a glass of milk at least once a dayleast once a day..

DIET RECOMMENDED FOR NEW DIET RECOMMENDED FOR NEW DENTURE WEARERDENTURE WEARER

Second and Third post insertion day

Vegetable-Fruit group: Juices; Tender cooked fruits and vegetables, (seedless and skinless).

Bread-cereal group: Cooked cereals, softened breads boiled, rice, noodles and macaroni.

Milk group: Fluid milk and cottage cheese. Meat group: Chopped beef, ground liver, tender

chicken/fish in a cream sauce, scrambled eggs, thick soups, etc.

The sample menu must include butter or margarine, a glass of milk at least once a day

DIET RECOMMENDED FOR NEW DIET RECOMMENDED FOR NEW DENTURE WEARERDENTURE WEARER

Fourth day and after

By the fourth day, or as soon as the sore spots have healed, firmer foods can be eaten in addition to the soft foods. These should ideally be cut into small pieces before eating. The sample menu must contain butter or margarine and a glass of milk.

NUTRITION COUNSELING AND DIETARY GUIDANCE FOR THE

ELDERLY

Since denture construction requires a series of appointments, dietary analysis and counseling can be easily incorporated into the treatment sequence.

The patient should be urged to see his physician for more detailed diagnostic procedures and treatment, when severe deficiency disease of any kind is present.

Can be educated by the dentist.

SUMMARYMany denture failures are the result of nutritional deficiencies.

Good health and nutrition of older patients are necessary for the

successful wearing of dentures.

Nutritional deficiencies may be a result from a combination of low calorie intake, poor chewing efficiency, the presence of chronic diseases if any, psychological problem.

Early in the treatment dentist can judge general adequacy of diet and address major deficiencies or refer the patient for care.

The patient must participate in developing nutrition goals and receive continued encouragement if dietary improvement is to occur.

BIBLIOGRAPHYBIBLIOGRAPHY1. Ava Knap : Nutrition And Oral Health In The Elderly. DCNA Jan-

1989;Vol:33, no.1:109-125. 2. C.M Heartwell: Syllabys Of Complete Dentures: 4th edition.

3. Detriot, Mich. Nutrition for Denture Patients. JPD 1960;10:53-60.

4. James C. Atikson et al. Salivary Hypofunction And Xerostomia: Diagnosis And Treatment. DCNA April-2005;Vol:49, no.2:309-326.

5. K.A Bandodkar, Meena Aras: Nutrition For Geriatric Denture Patients. JIPS- Jan-Mar 2005; vol:6, issue-1: 22-28.

6. Sheldon Winkler: Essentials Of Complete Denture: 2nd edition. Nutrition And Denture Wearing Tissues:22-39.

7. Zarb Bolender: Prosthodontic Treatment For Edentulous Patient: 12th edition. Nutrition Care For Denture Patients: 56- 70.

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