Nutrition Handout Abstracts 001. Wical, K.E., Swoope, C.C. Studies of residual ridge resorption.

Part II: T e relations ip of dietar! calciu" and p osp orous to residual ridge resorption. # Prost et $ent %&:1%'&1, 1()*. 00&. +arone, #. ,. Nutrition ' p ase one of t e edentulous patient. # Prost et $ent *0:1&&'1&-, 1().. 00%. /assler, /. Taste and s"ell in appetite. # Prost et $ent *%:%)*'%)(, 1(.0. 00*. Ni0el, 1. 2ole of nutrition in t e oral ealt of t e aging patient. $CN1 &0:3-(' 3.*, 1()-. 003. /c+ean, 4. 1. 2e5iew: T e i"portance of nutrition in oral ealt . #1$1 .(:10(' 11*, 1()*. 00-. 2a"se!, W. 0. Nutritional pro6le"s of t e aged. # Prost et $ent *(:1-'1(, 1(.%. 00). Wical, K. Co""on sense dietar! reco""endations for geriatric dental patients. # Prost et $ent *(:1-&'1-*, 1(.%. 00.. /assler, /. 7eriatric nutrition. a. Part I: 8steoporosis. # Prost et $ent *&:&3&' &3*, 1()(. 6. Part II: $e !dration in t e elderl!. # Prost et $ent *&:*.(, 1()(. c. Part I,: T e role of fi6er in t e diet. # Prost et $ent 30:3'), 1(.%. 00(. $ru""ond, #. Clinical and la6orator! diagnosis of nutritional pro6le"s. $CN1 &0:3.3'-00, 1()-. 010. 9artsoo:, E. ;ood selection, dietar! ade<uac!, and related dental pro6le"s of patients wit dental prost eses. # Prost et $ent %&:%&'*0, 1()*. 011. 4utwa:, 4. Continuing need for dietar! calciu" t roug out life. 7eriatrics &(:1)1' 1)., 1()*. 01&. #ac:son, et al. Nutritional considerations of t e ead and nec: cancer patient: So"e correlations in a retrospecti5e stud!. # Prost et $ent 3):*)3'*)., 1(.).

01%. Wood, 2. /., et al. Nutrition and t e ead and nec: cancer patient. 8ral Surg 8ral /ed 8ral Pat -.:%(1. 013. Clar:, $. E., et al. E5aluation of al5eolar 6one in relation to nutritional status during pregnanc!. # $ent 2es %:.(0. 01-. #o nson /S, 2$. Pre5enti5e nutrition: $isease'specific dietar! inter5entions for older adults. 7eriatrics ,ol. *), No. 11 No5 1((& pp. %('*(.

Section 16: Nutrition (Handout) I. Definition: T e science of food, t e nutrients and ot er su6stances t erein, t eir actions. interactions, and t e processes 6! w ic t e organis" ingests, digests, a6sor6s, transports, utili0es, and e=cretes food su6stances. Prost odontists are "ore trul! >gerontologists> t an an! ot er group of ealt professionals and pro5iding dietar! guidance for t ese patients can 6e a 5er! rewarding aspect of a dental practice. Tissues of t e oral ca5it! are often t e first to 6e affected 6! nutritional distur6ances. T is se"inar will focus on t e role of nutrition in t e oral ealt of t e aging patient and ot er clinical "anifestations w ic a patient "a! present wit . T ere are pro6le"s of selecting a properl! nutritious diet for an elderl! person. W at does Ni0el feel contri6uted to i"proper food selection? pg 3)). 1. &. %. *. 3. $eficient dentition 4ow econo"ic status Ingrained eating a6its E=cessi5e introspection 4oss of independence

T e essential nutrients are proteins, fats, car6o !drates, 5ita"ins, and water Protein re<uire"ents: +arone pg 1&& 1s t e patient 6eco"es older t e a"ount of protein re<uired increases. W at "a@or contri6ution does protein offer t e older patient? A 2esistance to infection, ane"ia, and loss of "uscle 5olu"e 8ne of t e "a@or reasons for protein deficiencies are cost. Ni0el pg. 3) W at ad5ice can we offer our patients? AC opped "eat, powdered dr! "il:

II. Vitamins AWater'solu6le 5ita"ins are + and C A;at'solu6le 5ita"ins are 1, $, E, and K. B1$EKC W at is t e difference 6etween water'solu6le and fat' solu6le 5ita"ins? A+arone pg 1&%. Water'solu6le 5ita"ins a5e "ini"al storage of dietar! e=cesses. $eficienc! de5elop rapidl! and t ese "ust 6e supplied dail!. ;at'solu6le 5ita"ins in e=cess are stored in t e 6od! and deficiencies are slow to de5elop. Clinical signs t at first present t e"sel5es are deficiencies in water'solu6le 5ita"ins in t e oral ca5it!. $iscuss so"e of t ese c anges descri6ed 6! $ru""ond Pg3.(. $escri6e dietar! sources of: Vitamin A: ,ita"in 1 "aintains t e integrit! of "ucous "e"6ranes and t e epit elial structures. Source? ;ats, dair! products, and eggs, li5er, and li5er oils, green leaf! and !ellow 5egeta6les. $eficiencies result in? Keratosis, =eropt al"ia, and growt failure, taste loss. Vitamin B comple : W at does it include? AT ia"ine B+1C for car6o !drate "eta6olis" Source? por:, organ "eats, lean "eats, !east, eggs, green 5egeta6les, cereals. $eficienc!? +eri6eri A2i6ofla5in B+&C effects ectoder"al tissue and needed for "eta6olic o=idation and pantot enic acid Banti6od! productionC Source? /il:, eggs, green 5egeta6les, li5er, eart $eficiencies? C eilosis and angular sto"atitis ANiacin: ;ound in lean "eats, li5er, !east, w ole grain and peanuts. $eficienc!? Pellagra A+1& found in li5er, :idne!, "uscle and "il: products, 6eans, lentils and peas. $eficiencies? Pernicious ane"ia, sore tongue, c eilosis, and c eilitis. A;olic acid: ;ound in green 5egeta6les, li5er, :idne!, and !east. $eficiencies? 7lossitis, c eilitis, and c eilosis. $eficiencies in t ia"ine and niacin produce? Confusion, depression, agitation, an=iet!, and ps!c osis. Vitamin !: Effects wound ealing, "aturation of 2+CDs, utili0ation of iron. A9ow is t e for"ation of 6one associated wit or effected 6! t e le5el of ascor6ic acid? Connecti5e tissue needed for t e "aintenance of t e for"ati5e cell function. Bosteo6lasts,odonto6lastsC $eficiencies? Scur5!, capillar! fragilit!, and ecc !"osis. Vitamin D: It en ances t e a6sorption of calciu" and is necessar! for calciu"' p osp orus "eta6olis". Considered t e "ost to=ic in e=cessEcausing !percalce"ia. Source? ;is li5er oils. $eficienc!? 2ic:ets I"portance of "inerals: In t e elderl! calciu" loss contri6utes to 6one fragilit! and

often t e! e=perience rapid and e=cessi5e ridge resorption. T is "a! 6e caused 6! a c ange in gastric acidit!, w ic 6egins to decrease in t e "iddle t ird of life, resulting in !poc lor !dria. Calciu" and ,ita"in C re<uire a strong acid en5iron"ent for opti"u" a6sorption. T is negati5e 6alance of calciu" contri6utes to t e de5elop"ent of osteoporosis. W at does /assler reco""end to ena6le calciu" utili0ation? Pg &3&. A/il: products t at are acidulated prior to ingestion to pro"ote a6sorption. W at can we reco""end to our patients? AFogurt and cottage c eese are acidulated "il: products. ;actors effecting calciu" "eta6olis": To "aintain a constant e=tracellular fluid calciu" concentration, calciu" is e=creted t roug t e :idne!s and gut w en t e concentration increases, or is recruited 6! a6sorption fro" t e gut or resorption fro" t e s:eleton w en t e concentration decreases. T ese "o5e"ents of calciu" are regulated 6! t e endocrine s!ste". Sweating, pregnanc! and lactation also produce calciu" loss. III. "ndocrine or#ans: W at principle endocrine organ influences calciu" "eta6olis"? 4utwa: pg 1)& AParat !roid glands and t e calcitonin'secreting ulti"o6ranc ial cells. W at are t ree wa!s t e parat !roid or"one influences calciu" resorption? 4utwa: pg 1)& 1. It increases a6sorption of calciu" fro" t e 7I tract &. It increases tu6ular rea6sorption of calciu" in t e :idne! %. It sti"ulates 6one resorption 1ll t ree ser5e to increase t e a"ount of calciu" in t e e=tracellular fluid. Pituitar! growt or"one "a! influence calciu" "eta6olis" indirectl! t roug its action on longitudinal 6one growt . $escri6e t is action: 4utwa: pg 1)%A Calciu" is "o6ili0ed fro" endosteal surfaces of t e diap !ses of long 6ones for redeposition at epip !ses. T !roid or"one can influence 6one "eta6olis" t roug nonspecific actions, increasing rates of 6ot 6one deposition and 6one resorption. In !pert !roid states, 6one resorption is increased. 1drenocortical or"ones control calciu" "o5e"ents at w at t ree sites? 1)% 1. 1t renal le5el, calciu" e=cretion is increased &. 1t t e 7I le5el, calciu" a6sorption "a! 6e in i6ited %. 1t t e s:eletal le5el, 6ot 6one for"ation and 6one resorption are in i6ited, wit a greater effect on 6one for"ation. 8steoporosis "a! 6e defined as a condition of too little 6one. 2adiograp icall! it cannot 6e diagnosed until appro=i"atel! %0G of 6one "ineral as 6een lost. $escri6e t e t eor! of de5elop"ent and pre5ention of osteoporosis: 4utwa: 1)*'1)3.

A Seru" calciu" concentrations are t e controlling factors in 6one "eta6olis". 1fter a calciu" containing "eal t e calciu" is a6sor6ed and enters t e e=tracellular fluid, raising t e seru" calciu" concentration. T e ulti"o6ranc ial cells, w ic respond detect t e increase, 6! secretion of calcitonin. Calcitonin in i6its furt er 6one resorption. 2enal and fecal secretion continue and t e net effect is t e lowering of t e seru" calciu" concentration. T e parat !roid detects t e lowered seru" calciu" concentration and respond 6! secreting parat !roid or"one. T is or"one sti"ulates 6one resorption in order to pro5ide additional calciu" to raise seru" calciu" concentration. T ere is a c!cle of calcitonin and parat !roid or"one secretion t roug out t e da! t at "aintains nor"al seru" concentration and s:eletal integrit!. 1000"g per da! of calciu" is a preli"inar! reco""endation of opti"u" calciu" inta:e in t e pre5ention of osteoporosis. Wical in5estigated B1* d record of "ealsH PanoC t e 5ar!ing degrees of residual ridge atrop ! and t e relations ip to calciu"Hp osp orus ratios. $escri6e is findings: pg 1. ACalciu" su6@ects: /ini"al resorption' calciu" inta:e (%% "g. Se5ere resorption 3%%"g. AP osp orus su6@ects: /ini"al resorption'1,&()"g and se5ere resorption ())"g. S!ste"ic influences: Wical pg1*. W ere is t e pri"ar! source of calciu"? Tra6ecular 6one. T e sites of tra6ecular 6one w ic suppl! "o6ile calciu" are t e @aws, ri6s, 5erte6rae, and t e ends of long 6ones. Bal5eolar 6one is affected firstC 9ow does calciu"Hp osp orus ratios affect an a5erage diet? AE=cess p osp orus in t e diet causes a secondar! !perparat !roidis" w ic in turn results in a6nor"al 6one resorption. T e pro6le" is co"pounded w en calciu" inta:e is inade<uate at t e sa"e ti"e. Inder t ese conditions al5eolar 6one, particularl! in t e "andi6le, is t e site of predilection for osteoporosis. IV. $ral problems in elderl% patients $iscuss eac of t e following: Ni0el pg 3.('(0. &ips: Pallor of la6ial co""issures, followed 6! fissuring, crac:ing and 6leeding 1ssociated wit ri6ofla5in and to a lesser e=tent re"aining +'co"ple=, iron and folic acid deficiencies. 'aste: Sensations are sweet, sour, salt! or 6itter. Percei5ed pri"aril! on t e tongue BSaltHsweetC, and lesser in t e ard and soft palates B6itterHsourC and p ar!n= Ball sensationsC. Taste for salt disappears first, sweet ne=t, lea5ing 6itter. >T e 6itter taste of aging> ;ungifor" papillae anterior &H% of tongue and respond "ore to sweet, sour, salt!. Circu"5allate papillae posterior t ird of tongue BsourH6itter to lesser degreeC ,ita"in 1 def. Bepit elial !per:eratosisC. Jinc is essential in t e renewal of Taste 6uds. /assler pg &*) (erostomia: dr!, atrop ic and so"eti"es infla"ed, or pale and translucent. CC:

6urning sensations and difficult! to c ew and swallow. /a@or cause of denture disco"fort and failure. T e 6est'"ade denture cannot 6e tolerated 6! de !drated fragile tissues in an e=cessi5el! dr! "out . 1ssociated wit +'co"ple= def., "enopause, an=iet!, dia6etics, cancer and alco olics. Sali)ar% #lands: Persistent sour taste, "etallic taste, or 6urning sensation. 8ften due to atrop ! of t e sali5ar! ducts in relation to =erosto"ia. 2elie5ed 6! increased inta:e of proteins and 5ita"ins 1, +, C, $. 'on#ue: Painful 6urning tongue, s"oot or 6ald tongue. Wo"en K triad of s!"pto"s: wea:ness, painful tongue, and nu"6ness or tingling of e=tre"ities. 1ssociated wit ,ita"in +1& deficienc! Bpernicious ane"iaC. *in#i)a: Painful, 6leeding, loose teet . $ru""ond P7 3(&. W at t!pes of 6acteria are associated "ore often in t e aged population wit niacin deficienc!? A+orrelia 5incentii. 1ssociated wit ascor6ic acid deficienc!. Prescri6e: T eragra" B,it + and C supple"entC '+,: as a result of "asticating food for !ears, 6ru=is", and attrition. Wit age t e glenoid fossa can 6eco"e s allower and t e ead of t e cond!le flatter causing pain and li"ited range of "otion. Head and Nec- cancer: #ac:son Bpg *)3C. %3G '-3G of cancer patients are "alnouris ed at ti"e of ad"ission. Tu"ors can act as a nitrogen trap and induce negati5e nitrogen 6alance. PatientDs i""ediate preoperati5e nutritional status pla!s a significant role in t e de5elop"ent of surgical co"plications. $uring periods of !pocaloric inta:e w at c anges occur? A+od! protein is i""o6ili0ed 6! gluconogenesis pro5iding fuel to "eet t e increasing endogenous 6asal and resting "eta6olic rates. In, addition, or"onal and 6ioc e"ical responses include low circulating insulin le5els and ele5ated catec ola"ine, glucagon, and cortisol le5els. T is or"onal profile pro"otes "uscle protein loss and increased rates of a"ino acid con5ersion to glucose. Ele5ated glucose and free fatt! acid le5els furt er rapid turno5er of nu"erous 6od! proteins suc as seru" al6u"in. V. .ood selection for t/e #eriatric patient 2ole of fi6er in t e diet: /assler 1. Sti"ulates growt of 6eneficial "icroflora &. 1cts to reduce a6sorption of c olesterol fro" t e stool %. 9!drop ilic propert! also a6sor6s t e to=ins t at are residual in t e stool *. 1llows for t e rea6sorption of water into t e tissues and a soft stool w ic passes at L %0 rs. 5s .0 rs. 1 6ig concern for t e elderl!M 3. Per"its rea6sorption of water'solu6le nutrients fro" t e colon Ine pensi)e balanced food c/oices and treatment #oals ;res , fro0en, or canned

1. &. %. *. 3. -. ). .. (.

Fogurt, cottage c eese, powdered "il: or c eddar c eeses ' once a da! T ic: 5egeta6le soup wit a "eat or poultr! 6one K once a da! C opped "eat, c opped tur:e!, c ic:en ;is : cod, snapper, addoc:, sole ;i6er, 6ran fla:es ' generic W ole grain 6reads softened wit stewed fruits Potato, rice Canned fruit K pears are 6est. ;res fruit K apples, pears, 6ananas, and figs. 7oal'directed acti5ities eac and e5er! da!

,ita"in supple"ents. /ini"u" regi"ent: ,it C %000"g per da! ,it +'100 co"ple= 1 per da! Calciu" citrate 1000'1*00"g per da! 0 Abstracts 0 160111. 2ical3 4. and S5oope3 !. Studies of 6esidual 6id#e 6esorpion. 7art II: '/e 6elations/ip of Dietar% !alcium and 7/osp/orus to 6esidual 6id#e 6esorption. , 7rost/et Dent 89:180913 1:;<. Purpose: To discuss so"e of s!ste"ic influences of calciu" and p osp orus and t eir relations ip to t e resorption of residual ridges Su6@ect: E5idence suggests a s!ste"ic co"ponent to al5eolar ridge resorption. 1"ong t e "an! recogni0ed s!ste"ic influences w ic affect t e resistance and resorption of 6one, calciu" deficiencies and calciu"'p osp orus i"6alances a5e 6een specificall! i"plicated as contri6uting factors in t e pat ogenesis of al5eolar 6one destruction and osteoporosis /aterials N /et ods: 1 stud! of ** co"plete denture patients, di5ided into two groups on t e 6asis of t e a"ount of al5eolar ridge resorption. 8ne group of 1* su6@ects ad "ini"al ridge resorption Bless t an one't ird original eig t of "andi6leC, and t e second group of %0 ad "ore se5ere resorption Bgreater t an one't ird "andi6ular eig tC. T e su6@ects :ept a record of t eir dail! "eals for two wee:s using preprinted for"s. T e diet records were anal!0ed for a5erage dail! inta:e of selected nutrients using standard food data. Conclusions: T is stud! s owed t at t ere is a positi5e correlation 6etween low calciu" inta:e, calciu" p osp orus i"6alance and "ore se5ere ridge resorption. ;or t e "ini"al ridge resor6ed group, t e "ean dail! calciu" inta:e was (%%"g B2$1 .00'1000"gC. T e group wit "ore se5ere resorption ad a "ean dail! calciu" inta:e of onl! 3%%"g. $ail! p osp orus inta:e was 1,&()"g for t e "ini"al resorption group and ())"g for t e "ore se5ere resorption group Bwit esti"ated ade<uate inta:e at 1000"gC. T e calciu" p osp orus ration was greater t an 0.) for t e "ini"all! resor6ed group, and less t an 0.) for t e "ore se5erel! resor6ed group.

$iscussion: Calciu" is 5er! closel! regulated 6! t e parat !roid gland. If t e seru" calciu" le5el decreases, t en t e pri"ar! source of calciu" 6eco"es tra6ecular 6one. 1l5eolar 6one is affected first, followed 6! t e ri6s and 5erte6rae, t en t e long 6ones. 1lso, in t e a5erage 1"erican diet, p osp orus inta:e can 6e two to t ree ti"es greater t an calciu" inta:e. Suc an i"6alance of p osp orus o5er calciu" as 6een i"plicated in t e pat ogenesis of 6one disease. 160119. Barone3 ,. V. Nutrition 0 7/ase one of t/e edentulous patient. , 7rost/et Dent Au# 1:;=3 Vol. <13 Num. 93 pp. 1990196. $efinition ' t e science of food, t e nutrients and ot er su6stances t erein, t eir actions, interactions, and 6alance in relation to ealt and disease and t e process 6! w ic t e organis" ingests, digests, a6sor6s, transports, utili0es, and e=cretes food su6stances. Tissues of t e oral ca5it! are often t e first to 6e affected 6! nutritional distur6ances. Essential nutrients are: proteins, fats, car6o !drates, 5ita"ins, and water. ' Protein: 1s t e patient 6eco"es older t e a"ount of protein re<uired increases. E=cess protein does not da"age t e ealt of older persons. $eficienc! results ion lower anti6od! production, reduced resistance to infection, ane"ia, and decrease in "uscle 5olu"e. 2esistance factor ' w en t e addition of a nutrient reduces t e ris: of disease and its eli"ination increases it. Protein is a resistance agent. ' ,ita"ins: Water solu6le ' + and C. $eficiencies often de5elop rapidl!, t e! "ust 6e supplied dail! and generall! do not a5e precursors. ' ;at solu6le ' 1, $, E, K. 1n e=cess is stored in t e 6od!, not e=creted. $eficiencies are slow to de5elop, so t e! are not a dail! necessit! in t e diet. T e! do a5e precursors. ' ,it 1: Is necessar! for "aintaining "ucous "e"6ranes and epit elial structures. $eficienc! ' :eratosis, and growt failure. ,it + co"ple= ' T ia"ine B+'1C ' for car6o !drate "eta6olis", and o=idati5e reactions. $eficienc! results in 6eri6eri ' 2i6ofla5in B+'&C ' for ectoder"al tissues, "eta6olic o=idation, anti6od! production, e"atopoietic and leu:opoietic s!ste"s. $eficienc! results in c ielosis and angular sto"atitis. ' Niacin ' found in "eats, li5er, !east, grains. $eficienc! results in pellagra ' ,it +'1& ' $eficienc! results in pernicious ane"ia, sore tongue, c eilosis, and c eilitis. ' ;olic acid ' found in green leaf! 5egeta6les. $eficienc! results in glossitis, c eilitis, and c eilosis. $eficiencies of t ia"ine and niacin produce confusion, depression, an=iet!, and ps!c osis. ' ,it C for ealing of wounds, "aturation of 2+CDs, e"oglo6in le5els, a6sorption of calciu" and iron, production of 6one. $eficienc! results in scur5!, capillar! fragilit!, and ecc!"osis. S"o:ers are usuall! seriousl! deficient in ,it C.

' ,it $ en ances t e a6sorption of calciu", is necessar! for calciu"'p osp orus "eta6olis". $eficienc! results in ric:ets. Is t e "ost to=ic of all 5ita"ins w en ingested in e=cess, causing !percalce"ia. /inerals: ' Calciu" loss contri6utes to 6one fragilit!. E=cessi5e ridge resorption "a! 6e related to a negati5e 6alance of calciu". T is "a! 6e caused 6! a c ange in gastric acidit!, w ic 6egins decreasing in t e "iddle t ird of life, resulting in !poc lor !dria. Since 6ot calciu" and ,it C re<uire a strong acid en5iron"ent for opti"u" a6sorption, deficiencies of t is t!pe are co""on in aged persons. T e result is a negati5e 6alance of calciu", w ic contri6utes to t e de5elop"ent of osteoporosis. T us it is eas! to understand t e retardation or e5en failure of t e 6od! repair in old people. Calciu" "a! 6e i"pro5ed 6! increasing t e inta:e of "il: products and using ,it $ supple"ents of *00 to 1,000 units a da!. Car6o !drate Tendenc! and 86esit!. /eta6olic rate of geriatric patients re<uires fewer calories. 1 soft diet t at is ig in car6o !drates and low in protein is usuall! co""on and t is produces o6esit!. 7eriatric patients. $enture tolerance in t e elderl! is "ar:edl! reduced, for t e pain t res old of soft tissue c anges "ar:edl! after t e "enopausal period and t e "ale cli"acteric. 4oss of tissue elasticit! resulting fro" degeneration of "uscle fi6ers, wit su6stitution 6! connecti5e tissue, co""onl! e=ceeds (0G. Capacit! for repair t roug cell di5ision and tissue o=idation is reduced. T ere is an e=tre"e reduction in t e capacit! to perfor" acti5ities re<uiring new "otor pat wa!s. Protein $eficienc!. 1ged patients re<uire additional protein, and t ere is an inti"ate relations ip 6etween t e inta:e <uantit! and t e capacit! for utili0ation of ingested calciu". $ou6ling t e protein results in a t reefold increase in calciu" utili0ation. 1ged oral "ucosa. Keratini0ed la!er is t in or a6sent, 6eing fria6le and easil! in@ured. 4oses its "oisture, fat, and elasticit!, less 5ascular, eals "ore slowl!. In response to irritation it "a! 6eco"e !per:eratatic. Sali5ar! glands. $i"inis in t eir function. Oerosto"ia results in a6nor"al taste sensations. Sali5a 6eco"es t ic: and rop!. /out is arder to :eep clean 6ecause food particles ad ere "ore tenaciousl!. T is predisposes t e "ucous tissue to "ec anical irritation and a resulting 6urning sensation. +urning sensations, persistent sour or "etallic taste, and atrop ic glossitis are often reli5ed 6! ,it + plus increased protein inta:e. ,ita"ins contri6ute to ner5e sta6ilit! and resistance to 6acterial infection 6! pro"oting growt of ealt ! tissue. 1ll 5ita"ins, especiall! 1, + co"ple=, C, and $ s ould 6e increased in aged persons. Post"enopausal wo"en. 16nor"al taste and 6urning sensation are related to low

estrogen and 5it + co"ple= deficiencies. 8steoporosis. 1 loss of 6one "ass pro6a6l! due to se= or"onal deficienc!, is co""on in t e post"enopausal period, and t e adaptation of t e tissues under new dentures "a! 6e affected. Can result fro" a low dietar! inta:e of calciu" for a long period of ti"e .It can 6e pre5ented and possi6l! alted 6! a diet ig in calciu" "aintained t roug out life. Stress ' Effect on nutrition. Stress fro" infection, or trau"a, or of a ps!c ological origin as 6een s own to result in poorer nutritional status. Stress is capa6le of increasing e=cretion of nitrogen, 5it 1, and 5it C, and e5en causing a net loss to t e 6od!. So"e nutrient 5alue is lost at e5er! step in "illing, free0ing, canning, de !dration, refrigeration, transportation, and storage. T is "a:es a strong case for t e addition of food supple"ents. C eras:in sa!s t at %0')0G of patients a5e a poor ,it C le5el. Pa!ne feels t at al"ost all denture patients are nutritionall! deficient and prescri6es ascor6ic acid for t e". 160118. +assler3 +aur% DDS3 +S. *eriatric nutrition: '/e role of taste and smell in appetite. , 7rost/et Dent <8:9<;09<:31:=1. 1 "a@or reason for denture failure in t e elderl! patient is deficient tissue tolerance resulting fro" inade<uate nutrition. Elderl! people are notoriousl! poor eaters and fre<uentl! "alnouris ed. T e! often suffer fro" a loss of appetite due to di"inis ed senses of taste and s"ell. Wit age, t e appetite centers Bli:e ot er 6rain centers suc as "e"or!, earing, and sig tC decline so t at appetite no longer operates to sti"ulate a desire for food. 'aste buds: T ese are co"ple= epit elial structures w ic trans"it taste sensation to t e 6rain. T e! are s ort li5ed and renew e5er! ten da!s. T is renewal is slowed in t e elderl!, especiall! post "enopausal wo"en as estrogen and protein are essential to taste 6ud renewal. ;ilifor" papillae pro5ide t e tongue wit its gra! surface coating and rarel! a5e taste 6uds. T e fun#iform papillae are idden wit in t e filifor" papillae and a5e ner5e endings in t e .epit eliu". T ese taste 6uds are located in t e anterior 9>8rds of t/e ton#ue and respond to s5eet3 sour3 or salt% foods. T e! are "ediated 6! t e intermedius branc/ of t/e facial ner)e. T e circum)allate papillae are located near t e base of t/e ton#ue and respond to bitter sti"uli. T e! are "ediated 6! t e #lossop/ar%n#eal ner)e. We do not taste all su6stances t e sa"e. +itter taste are detected at a "uc lower le5el t an acid, w ic is detected 6efore salt w ic is detected 6efore sweet. T e taste for salt see"s to go awa! earl! in life and sweet foods go soon after. Smell: 2eceptors ang fro" t e cri6rifor" plate at t e 6ase of t e s:ull. T e! are renewed e5er! %0 da!s. T is process slows wit age, "uc "ore rapidl! t an taste. A prost/odontist can /elp elderl% patients b%:

' Testing all patients past 30 !ears of age for taste and s"ell. ' Encourage patients to c ew s"all pieces of "eats, fruits, carrots, green peppers, and celer! to elp sti"ulate sali5a, w ic increases taste, w ic increases appetite. ' Infor"ing patients to a5oid peanuts as t e! cause constipation. ' Instruct t e patient to add fla5orings to food 6ut a5oid salt and sugar. T e elderl! tend to li:e 5anilla, orange, straw6err!, and c err! fla5orings to sti"ulate t eir appetite. ' Instruct t e patient to add tongue 6rus ing to t eir oral !giene regi"en. ' Tell t e patient to <uit s"o:ing. 16011<. Ni?el3 A. 6ole of Nutrition in t/e $ral Healt/ of t/e A#in# 7atient. D!NA 91:@6:0@=<. $iscussion: 8ral Pro6le"s: ' 4oss of taste ' Oerosto"ia ' +urning tongue ' 8ral /ucous /e"6rane Pro6le"s ' T/# Pain ' 7ingi5itis ' 1l5eolar osteoporosis Nutrient re<uire"ents: ' Calories and car6o !drates ' ;ats ' Protein ' Calciu", p osp orous, ,it. $, and fluorides ' ,it. +1&, folic acid, and iron ' ,it. + co"ple= and ,it. C ' $ietar! fi6er ' ;ood selection ' $iet suggestions for t e denture wearer 16011@. +cBean3 &. A 6e)ie5: '/e Importance of Nutrition in $ral Healt/. ,ADA =::11:011<3 1:;<. $iscussion: $ental caries occurs w en 6acterial en0!"es wit in t e dental pla<ue fer"ent dietar! car6o !drate, principall! sucrose, wit t e for"ation of organic acids. T e organic acids diffuse out of t e pla<ue and attac: t e toot Ds ena"el. $ecalcification occurs in 6ot ena"el and dentin. Calciu", p osp orus, 5ita"in $, fluoride, and protein are i"portant in t e de5elop"ent of toot structure wit increased resistance to deca!. ;luoride in a concentration of 1 pp" in t e drin:ing water reduces t e incidence of dental caries. T e a"ount of dental pla<ue and t e incidence of caries are affected 6! nutrition. T e nutrients in t e diet influence t e 6acterial proliferation or cariogenic flora. 1 low protein, ig car6o !drate diet pro"otes cariogenic 6acteria. Sucrose is a

"a@or cariogenic food, 6ut starc is t e least cariogenic car6o !drate. T e co"position of sali5a can 6e influenced 6! nutrition. 1 ig protein diet increases t e sali5ar! urea le5el and will neutrali0e acids. ;ats inder acid penetration into t e ena"el 6ecause of t eir capacit! to perfor" a protecti5e oil! fil" on t e surface of t e teet . 4ac: of proper nutrition can affect t e rate and degree of periodontal disease, 6ut it does not initiate it. $eficiencies of 5ita"ins 1 and + can affect t e epit eliu". ,ita"in C deficienc! can cause t e periodontal tissue to 6e "ore suscepti6le to 6rea: down 6! local irritants. Nutrition as "ore of a conditioning rat er t an a causati5e factor in periodontal disease. 160116. 6amse%3 2. $. Nutritional 7roblems of t/e A#ed. , 7rost/et Dent <::160 1:3 1:=8. $iscussion: ;our factors t at deter"ine t e nutritional status of geriatric patients are: genetic factors, cultural, socioecono"ic, and 6iologic conco"itants of t e aging process. T is article re5iews t e 6iologic conco"itants of aging t at ad5ersel! affects t e nutritional status of geriatric patients regardless of dietar! inta:e. Fou a5e a decreased functional capacit! of aging cells in t e ner5ous and s:eletal "uscle s!ste"s, and a 5olu"etric loss of up to 1H% of t e lean "uscle "ass of t e 6od! 6! age )3. T is "a! result in i"paired "asticator! force and neuro"uscular incoordination. +! age *3, a decrease in t e nu"6er of taste 6uds occurs. T e a6ilit! to identif! pri"ar! taste <ualit! re"ains, 6ut discri"ination of su6tle 6lending fla5ors occurs. $r! "out and altered taste decrease t e pleasure of eating. 1 diet in large a"ounts of co""erciall! prepared con5enience foods is ig in car6o !drates and calories, 6ut low in protein and 5ita"ins. 1 decreased inta:e of calciu" and e=cessi5e inta:e of p osp orus can lead to osteoporosis. T e "icro6ial population of t e oral ca5it! undergoes significant c ange during a life span. 4acto6acillus acidop ilus is predo"inant in c ildren, streptococcus "utans in "iddle age, and actino"!ces predo"inate in old age. T e gastrointestinal tract is affected 6! t e aging process. $ecreased intestinal "otilit! allows 6acteria to proliferate and co"petes wit t e ingestion of nutrients, especiall! a"ino acids and 5ita"ins. 1 significant decrease occurs in t e a6sorpti5e capacit! of t e s"all intestine. /il: of "agnesia Bla=ati5e and antacidC adsor6s nutrients B5ita"insC. /ineral oil la=ati5es 6ind and pre5ent a6sorption of fat solu6le 5ita"ins. ,egeta6le fi6er la=ati5es "a! contain up to 30G de=trose Ba dia6etic a0ardC or a ig salt content. Weig t loss and osteoporosis occur in 13G of t e population o5er age -0. $i5erticulosis causes decreased intestinal "o6ilit! and constipation. 4i5er d!sfunction is co""on in t e elderl!. W en ad5anced li5er i"pair"ent e=ists, specific a"ounts and t!pe of protein "ust 6e a5aila6le. 8ne g"Hda!H:g of 6od! weig t of dietar! protein is needed for t e ealt ! indi5idual. 16011;. 2ical3 DDS. !ommonsense dietar% recommendations for t/e #eriatric

dental patients. , 7rost/et Dent .eb1:=83 Vol. <:3 Num. 93 pp1690168. Elderl! people suffer fro" "alnutrition. So"e reasons are decreased appetite, i"paired digestion, decreased a6sorption, i"paired glucose tolerance, and effects of drugs. Signs suggesti5e of nutritional deficiencies are atrop ic "ucous "e"6rane, e=cessi5e resorption of al5eolar 6one, and slow ealing responses. 2efer to a registered dietitian. It is i"portant t at t e dietitian recogni0e t e andicaps faced 6! a patient wit i"paired "asticating a6ilit! w en preparing diets and "enus for t ese patients. 1 +alanced $iet ' four or "ore ser5ings of 5egeta6les or fruits ' four ser5ings of w ole grain cereal foods ' t ree ser5ings of "il: or c eese ' t ree or "ore ser5ings of "eat or ot er protein foods ' one teaspoon of 5egeta6le oil ' si= glasses of water Practical $ietar! Suggestions. Soups contain 5ita"ins, "inerals, protein, fi6er, and water. Fogurt and c eeses is a source of calciu" and 5it $ for t ose w o a5oid "il:. $enture tolerance is i"pro5ed wit a ig er inta:e of protein. T ree ser5ings of protein foods eac da! and t e use of ig <ualit! ani"al protein is stressed. W ole grain 6reads and cereals pro5ide protein, 5ita"ins, and "inerals. 2efined car6o !drate foods, w ic "a:e up t e 6ul: of t e diets of "ost geriatric patients, suppl! little "ore t an calories, wit relati5el! insignificant a"ounts of ot er essential nutrients. W ile energ! needs decrease wit aging due to slowing of 6od! "eta6olis" and reduced p !sical acti5it!, t e re<uire"ent for protein, 5ita"ins, car6o !drates, water, and essential fatt! acids re"ain t e sa"e. If less food is eaten due to decrease needs and di"inis ed appetites, t e c oice of foods t at are a6le to suppl! t e re<uired essential nutrients 6eco"es e5en "ore critical. Indications for Supple"ents. ,ita"in and "ineral supple"ents "a! fa5ora6l! i"pro5e t e poor nutrient'to'calorie ratios of t e fre<uentl! encountered soft car6o !drate diet. +rin and +auerfeind o6ser5ed t at it costs less to supple"ent diets wit "ulti5ita"ins t an to 6u! t e necessar! foods to correct 5ita"in deficiencies. 16011=a. +assler3 +. *eriatric Nutrition. 7art I: $steoporosis. , 7rost/et Dent <9:9@909@<3 1:;:. $iscussion: 8steoporosis results fro" t e loss of 6one especiall! fro" supporting 6ones suc as: 5erte6ral colu"n, epip !ses of long 6ones, t e "andi6le and fingers. T e negati5e calciu" 6alance causing loss of 6one occurs fre<uentl! in elderl! patients, especiall! in post "enopausal wo"en. T e low estrogen le5el in t ese patients affects t e 6one cells in utili0ing t e calciu" wit in t e cells. T e pri"ar! cause of osteoporosis is t e low inta:e of calciu" ric foods, "ainl!

"il: and "il: products. 4ac: of calciu" a6sorption is anot er "a@or cause of low calciu" le5els. T e calciu" "ust 6e acidulated 6efore ingestion in elderl! patients 6ecause of t e lac: of !droc loric acid in t e sto"ac t at assists a6sorption of all "inerals in t e s"all intestine. Fogurt and cottage c eese are acidulated "il: products. 4actase deficienc! results in lactose intolerance and is co""on in elderl! persons. In t e second loop of t e s"all intestine, lactase is secreted and degrades and a6sor6s t e lactose of "il: and "il: products. 4actose intolerance 6egins w en a person stops drin:ing "il: and t e lactose en0!"e is no longer secreted. T is leads to diarr ea, flatulence, disco"fort and decreased calciu" a6sorption. 16011=b. +assler3 +aur% DDS3 +S. *eriatric nutrition: 7art II: De/%dration in t/e elderl%. , 7rost/et Dent <9:<=:0<:131:;:. Water is pro6a6l! t e "ost i"portant and essential nutrient in t e diet of "an. +od! water ser5es a function si"ilar to t at of t e oil w ic 6at es and lu6ricates t e "o5ing parts of a "ac ine. effects of $e !dration on t e ' S:in: Wrin:les and aging. ' /uscle: T e "uscle s rin:s and results in sagging. ' Secretions: Sweat and se6aceous gland secretions di"inis . ' E!es: $r! e!es due to di"inis ed secretions of tears. ' /out : Oerosto"ia ' Causes for c ronic water loss and tissue de !dration ' Kidne! da"age due to !ears of secreting to=ins. ' Kidne! da"age due to alco ol use. Earl! signs ' Nocturia: Kidne!s fail to rec!cle fluids, also a less elastic 6ladder ' Tissue ede"a: 1n:le ede"a, Palatal ede"a at nig t ' P !sical disco"fort: ;atigue ac es and pains ' E"otional factors: $epression, an=ieties, and inso"nia Treat"ent: 1cute: /uc easier to treat using intra5enous and su6cutaneous fluids. C ronic: Can 6e alted if not treated 6! @udicious and correct ingestion of water 6ound foods. ;ree water passes to <uic:l!, 6ut water 6ound to an organic or inorganic "olecule can 6e elpful. Practicall! spea:ing t is is soup. ,egeta6le fi6ers can 6e added to elp eli"inate constipation. Pearls fro" t e article: ' Negati5e water 6alance: /ore goes out t an in a6sor6ed. ' Oerosto"ia is a "a@or cause of denture disco"fort and failure. ' Water 6alance is efficientl! ac ie5ed in t e elderl! t roug t e ingestion of soup. 16011=c. +assler3 +aur% DDS3 +S. 7art IV: '/e role of fiber in t/e diet. , 7rost/et Dent @1:@0;3 1:=8. 16stract not a5aila6le at t is ti"e ......

16011:. Drummond3 ,. !linical and laborator% dia#nosis of nutritional problems. D!NA 91:@=@06113 1:;6. Purpose: To descri6e practical clinical signs and la6orator! "et ods t at can 6e used to aid in t e diagnosis of specific nutrient deficiencies. $iscussion: /et ods for assessing nutritional status: Beac focuses on a specific stage of t e deficienc!C 1. 9istorical e5aluation of dietar!, social, and "edical e=periences. &. Clinical e5aluation of t e patient. %. 4a6orator! and 6ioc e"ical "et ods of assess"ent. *. T erapeutic trials. T e first clinical signs of "an! nutrient deficiencies Bespeciall! water solu6le 5ita"insC are seen in t e oral ca5it!. ' Protein' onl! practical assess"ent is 6! dietar! istor!. ' ,ita"in 1' anal!sis of seru" and plas"a le5els. ' ,ita"in $' no direct la6 "easure"ent, rel! on indirect "easure"ents of calciu", p osp orus and al:aline p osp atase. ' ,ita"in E' seru" le5els ' ,ita"in K' "easure prot ro"6in acti5it! of t e plas"a. ' ,ita"in C' "easure plas"a or seru" le5els and w ite 6lood cell'platelet ascor6ic acid concentrationsB6est indicator of tissue storesC. ' T ia"ine' urinar! testing useful for se5ere and long standing deficiencies. B"easure"ent of 6lood le5els is "ore relia6leC. 2i6ofla5in' "easured in red 6lood cells. Niacin' "easured in urinar! "eta6olites. +1&' seru" and urine and dietar! istor!, t erap! is rapid 6! clinical t erapeutic trial. ;olic acid' "easure"ent in seru". Iron' seru" iron or transferrin saturation. Calciu"' assessed 6! dietar! istor!. ;or la6orator! testing t e dentist as t e option to: 1. Ta:e t e sa"ple in t e office &. 2efer Patient directl! to a clinical la6. %. 2efer to a p !sician for "eta6olic testing. 160111. Hartsoo-3 ". .ood selection3 dietar% adeAuac%3 and related dental problems of patients 5it/ dental prost/eses. , 7rost/et Dent 89:890<131:;<. Purpose: To deter"ine if a relations ip e=ists a"ong dental status, food selection, and nutritional ade<uac! of t e diet. Su6@ect: 1n anal!sis of t e eating patterns of su6@ects and t e relation of t e for"s of food a5oided and su6stituted to t e t!pes of prost etic restorations. /aterials N /et ods: 1 stud! of *- full! or partiall! edentulous patients ranging fro" %) to ). !ears of age. Wo"en co"prised )0 percent of t e sa"ple. 1 <uestionnaire

di5ided into t ree sections was used. T e first area of e5aluation was t e e=isting dietar! restrictions and collection of data on food inta:e. T e second area was co"prised of e5aluation of t e dentition, ad@ust"ent to t e prost esis, and sensiti5it! of taste, T e t ird section dealt wit food preference. Eac su6@ectPs dental status was assessed. 2esults: 3& percent of t e su6@ects ad co"plete dentures. (& percent reported t eir dentures were co"forta6le. +ot "en and wo"en ad less t an desira6le inta:es of calciu" and 5ita"in + co"ple= w en co"pared to ot er nutrients. $ietar! inta:es of older indi5iduals was not as ade<uate as !ounger indi5iduals. Iron deficienc! was 5er! co""on in t e elderl!. T ose w o were full! or partiall! edentulous for greater t an -.3 !ears ad an inade<uate dietar! inta:e w ile t ose less t an -.3 !ears ad a 6etter dietar! inta:e. T e co"plete denture group ad t e "ost desira6le dietar! pattern, t erefore t e sta6ilit! of t e dental restoration ad little effect on t e ade<uac! of t e diet. C ewing toug "eat was t e onl! pro6le" reported 1ll groups reported altered taste e=cept t ose wearing a "a=illar! re"o5a6le partial denture opposing natural teet . T e altered taste generall! decreased wit ti"e. Conclusions: Su6@ects o5er age )0.3 !ears ad t e least satisfactor! diets. Prost etic restorations do affect t e a6ilit! of patients to consu"e certain for"s of food suc as 6eef stea: or cara"els, 6ut do not li"it t e o5erall ade<uac! of t e diet. 1 si"ple dietar! screening procedure could 6e e"plo!ed for all patients. T ose wit poor nutritional inta:es s ould 6e referred to a nutritionist. If it is i"practical to screen all patients, t e e"p asis s ould 6e placed on t ose indi5iduals o5er t e age of )0.3. 160111. &ut5a-3 &. !ontinuin# Need for Dietar% !alcium '/rou#/out &ife. *eriatrics 9::1;101;=3 1:;<. Purpose: To re5iew t e p !siolog! of calciu" in t e 6od! and stress t e i"portance of dietar! calciu" supple"ents in t e pre5ention of osteoporosis. $iscussion: Calciu" in t e for" of calciu" !dro=!apatite is t e "a@or s:eletal co"ponent B((GC w ile t e re"aining 1G is distri6uted in t e EC;; and in t e "e"6ranes of cells. Calciu" in "e"6ranes ser5es as a "eans to transport nutrients and energ!, w ile in t e EC; it elps in t e p !siolog! of ner5e trans"ission and 6lood clotting "ec anis"s. Calciu" is o6tained in one wa!. T roug a6sorption fro" dietar! source. It is lost 6! renal Clearance Brelati5el! independent of dietar! calciu"C 100'&00"g dail!, and also t roug e=cretion t roug t e feces at a6out 1&3'1.0"g dail!. $er"al losses are insignificant. In wo"en, ot er factors in t e loss of calciu" in t e last tri"ester of

pregnanc!, &3'%0g" of calciu" is deposited in t e fetal s:eleton and 300')00"g is secreted in "il: during lactation. T e parat !roid or"one influences calciu" "eta6olis" 6! increasing a6sorption fro" t e gut, increasing tu6ular rea6sorption fro" t e :idne! as well as resorption fro" t e 6one. Calcitonin as 6een s own to specificall! in i6it resorption of s:eletal calciu". Pituitar! growt or"one "a! influence calciu" t roug its action on t e longitudinal 6one growt . 9ere calciu" is "o6ili0ed fro" endosteal surfaces of t e diap !ses of long 6ones for deposition at t e epip !ses. T !roid or"one can act to influence 6one "eta6olis" t roug non'specific actions of increasing 6ot 6one resorption and deposition. 1drenocortical or"ones control calciu" "o5e"ents at t ree different sites: 2enal'calciu" e=cretion is increases, 7ut' Calciu" a6sorption is in i6ited, S:eletal le5el' 6ot 6one for"ation and resorption are in i6ited. 8steoporosis as 6een defined as a condition of too little 6one. Estrogens a5e also pla!ed a contro5ersial role. 2adiograp icall! it cannot 6e detected until %0G of t e 6one is lost. $ietar! sur5e!s s ow patients wit osteoporosis, generall! a5e low calciu" diets. 8nce 5erte6ral fracture as occurred, t e osteoporosis cannot 6e re5ersed, onl! slowed. T e efficienc! of calciu" a6sorption as 6een s own to decrease wit age, t us pre5enti5e t erap! s ould 6e instituted. 1000"gs of calciu" are reco""ended per da! and ig l! reco""ended in t e t ird to fourt decades as a pre5entati5e regi"ent. 160119. ,ac-son3 +,. "t al. Nutritional !onsiderations of t/e Head and Nec!ancer 7atient: Some !orrelation in a 6etrospecti)e Stud%. , 7rost/et Dent @;:<;@0<;=3 1:=;. Purpose: To outline t e clinical and la6orator! criteria for nutritional assess"ent in t e oral cancer patient and to esta6lis a correlation 6etween t e nutritional status of a patient and factors li:e tu"or t!pe, e=tent, and 6lood c e"istr!. /et ods N /aterials: &( patients wit 5arious stages of carcino"a of t e ead and nec: were e5aluated and nutritional status 6efore treat"ent was deter"ined. Seru" al6u"in and total protein le5els were to indicate le5el of "alnutrition. $iscussion: /ost ead and nec: cancer patients suffer fro" poor nouris "ent. %3'-3G of patients ad"itted for cancer t erap! are "alnouris ed. /alnutrition increases "or6idit! and "ortalit! and co"pro"ises treat"ent. T e greatest indicator of "alnutrition is a rapid weig t loss of 10G 6od! weig t o5er a 1'% "ont period. 1 "alignanc! di5erts nutrition awa! fro" t e ost and can lead to anore=ia, cac e=ia, i"paired food a6sorption, increased energ! e=penditure and e"otional and ps!c ological reactions. Pre'e=isting nutritional deficiencies can 6e t e result of alco olis", poor eating a6its, ea5! s"o:ing, lac: of nutritional :nowledge, poor natural teet or ill fitting dentures, lac: of funds to 6! nutritious food and an=iet! induced anore=ia. Clinical and la6orator! tests are essential to deter"ine a patients nutritional status and to coordinate treat"ent "odalities to ac ie5e t e "ost fa5ora6le outco"e.

Conclusion: 8nl! t roug t e infor"ation gat ered fro" a istor!, p !sical e=a", and la6orator! tests can an o6@ecti5e assess"ent of a patientPs nutrition 6e drawn. 1 properl! nouris ed patient will a5e an i"pro5ed prognosis regardless of t e treat"ent "odalit!. 160118. 2ood3 6+ et al. Nutrition and t/e /ead and nec- cancer patient. $ral Sur +ed $ral 7at/ 6=: 8:108:@ Purpose: To re5iew t e 6enefits of nutritional support, "et ods of patient assess"ent and nutritional repletion, and t e ad5antagesHdisad5antages of 5arious ali"entation "odalities. /et ods: 2ecords of *0 patients were re5iewed w o ad surgical treat"ent for stage III and stage I, surger! of t e ead and nec: region. T e nutritional of eac patient was assessed 6! t e patients ideal 6od! weig t BI+WC, and se5eral la6 tests ie. seru" al6u"inHtransferin, and total l!"p oc!tes. 8f t ese *0 patients, 1. ad "ini"al "alnutrition, 1* ad "oderate "alnutrition, and . were se5erel! "alnouris ed. T ese patients were followed postoperati5el! for surgical co"plications, ie. infection, surgical site 6rea:down, fistula, loss of flap, or prolonged ospitali0ation BQ&1 da!sC. 2esults: Co"plications de5eloped in 1* of t e *0 patients B%3GC and t e 6rea:down is as follows: 1 of 1. B"ini"al "alnutritionC ad co"plications - of 1* B"oderate "alnutritionC ad co"plications ) of . Bse5ere "alnutritionC ad co"plications In t e && patients wit "oderateHse5ere "alnutrition, 1% of && B-3GC ad postoperati5e co"plications. '/is s/o5s a definite correlation bet5een t/e de#ree of malnutrition and de)elopment of postoperati)e complications. Conclusions: T is article ga5e a good o5er5iew of t e 6enefits of nutrition and t e i"portant role it pla!s in t e pre5ention of postoperati5e co"plications. It re5iewed a "et od 6! w ic "alnutrition can 6e classified, using ideal weig t and la6 5alues. T ere was also infor"ation on t e "et od of feeding, pending t e p !sical status of t e patient. 8ral 6lenderi0ed food, nasogastricH@e@unosto"! tu6e feedings, and t e parenteral route were discussed. None of t e *0 patients recei5ed preoperati5e nutritional t erap!, and t e aut ors ac:nowledge t at t e patientDs preoperati5e nutritional status could 6e i"pro5ed. T e! raised t e <uestion of w et er treat"ent s ould 6e dela!ed to allow for a period of nutritional ali"entation. 16011<. 2ood3 6+3 et al. Nutritional and t/e Head and Nec- !ancer 7atient. $ral Sur# $ral +ed $ral 7at/ 6=:8:108:@3 1:=:. Purpose: To re5iew t e 6enefits of nutritional support, t e "et ods of patient assess"ent and nutritional repletion, and t e ad5antages and disad5antages of 5arious ali"entation "odalities. /alnouris "ent can result fro" a nu"6er of factors in patients t at a5e ead and

nec: neoplas"s. /an! a5e a istor! of alco olis", ea5! s"o:ing, poor diets and poor oral !giene. T e tu"or also "a! 6e causing pain, tris"us, or an ill fitting denture. 1nore=ia resulting fro" an=iet! and t e tu"or itself can influence t e "eta6olic needs of t e patient. Surgical resection "a! restrict or eli"inate oral inta:e and infections, fistulas, wound de iscence can increase "eta6olic needs and decrease i""unoco"petence. 4oss of taste sensation, =erosto"ia, sto"atitis and "ore 5iscose sali5a can result fro" radiation and c e"ot erapeutic agents can cause nausea, 5o"iting, and diarr ea w ic will also affect a patients nutritional status. 1 p !sical e=a", dietar! istor!, and la6 wor:'up are necessar! to assess t e patients nutritional status. 8nce a nutritional status is esta6lis ed, t e "et od of feeding can 6e decided. It can 6e 6! 6lenderi0ing food and adding li<uid supple"ents t at t e patient can ta:e orall!. Enteral feeding "a! 6e necessar! t roug a nasogastric tu6e or a tu6e surgicall! placed in t e sto"ac or @e@unu". So"e need total parenteral nutrition usuall! gi5en t roug a central 5enous cat eter in t e su6cla5ian 5ein continuousl! o5er a &* r. period. T e nutritional status s ould 6e reassessed to insure proper "eta6olic functions are ac ie5ed. /et ods N /aterials: *0 patients treated wit stage III and I, "alignancies of t e ead and nec: region were re5iewed to co"pare t e state of "alnutrition wit t e li:eli ood of post'surgical co"plications. 2esults: *%G of t e "oderatel! "alnouris ed patients and .)G of t e se5erel! "alnouris ed patients de5eloped co"plications. Conclusion: E5en wit postoperati5e nutritional t erap!, co"plications still arose. T e preoperati5e nutritional status of a ead and nec: cancer patient will significantl! influence t eir total oncologic treat"ent. 16011@. !lar-. ")aluation of Al)eolar Bone in 6elation to Nutritional Status Durin# 7re#nanc%. , Dent 6es 6:(8):=:10=:@3 +arc/3 1::1. Purpose: To identif! s ort'ter" effects of pregnanc! and dietar! inta:es of calciu", p osp orus, protein, and 5it C on t e radiograp ic densit! and al5eolar crest "orp olog! of t e "andi6le. $e"and for nutrients necessar! for t e for"ation of "inerali0ed tissues increases dra"aticall! during pregnanc! to "eet fetal re<uire"ents. ,ita"in C inta:es s owed a positi5e correlation wit 6one densit! c ange. Calciu" inta:es s owed a negati5e, 6ut not significant, correlation wit 6one densit! c ange, contri6uted particularl! 6! su6@ects wit t e ig est calciu" inta:es. T e strongest relation wit al5eolar crest "orp olog! c ange was t e interpro=i"al poc:et'dept 'c ange. T e net loss c ange in al5eolar crest "orp olog! was "ore pronounced t an net gain c ange B'.*% "" 5s. R.&0 ""C. 4ittle c ange in t e periodontal status occurred during t e course of t e pregnanc!, and an! o6ser5ed c ange could 6e related to nutritional 5aria6les. 160116. ,o/nson +S3 6D. 7re)enti)e nutrition: Disease0specific dietar% inter)entions for older adults. *eriatrics Vol. <;3 No. 11 No) 1::9 pp. 8:0<:.

Coronar! eart disease: ' 2educing fat inta:e ' less t an %0G of total calories is reco""ended. ' No "ore t an *0'-0 gHd. W en weig t loss is not a goal, for"er fat calories would 6e 6est replaced 6! car6o !drate calories, prefera6l! co"ple= and unrefined. Sources are w ole grain products, fruits, and 5egeta6les. Co"ple= car6o !drates pro5ide solu6le fi6er, w ic is :nown to 6e effecti5e at reducing total seru" c olesterol. ' Effect of fis oil ' o"ega'% pol!unsaturated fatt! acids found in fis oil are 6eneficial fats. ' 1ntio=idant nutrients ' ,it E, C and 6eta'carotene Ba precursor of 5it 1C. T eories suggest t at o=idation of lipoproteins in t e 6lood "a! result in pla<ue for"ation and at erosclerosis. ' Trace ele"ents ' copper and c ro"iu". ' low copper status "a! lower 9$4 c olesterol. ' c ro"iu" as 6een s own to reduce ele5ated seru" c olesterol le5els. ' 2educe or control 6lood pressure ' 2educe or control 6lood glucose in persons wit adult'onset dia6etes "ellitus. 9!pertension: ' Pre5ention is weig t loss or "aintenance of nor"al 6od! weig t. ' Sodiu", potassiu" ' decrease sodiu", and increase potassiu" inta:e. ' 8lder persons wit !pertension are "ore li:el! t an !ounger !pertensi5es to e=perience a reduction in 6lood pressure as a result of salt reduction. ' Positi5e correlation 6etween sodiu" inta:e and 6lood pressure e=ists. ' Negati5e correlation 6etween potassiu" inta:e and 6lood pressure e=ists. ' Positi5e correlation 6etween t e sodiu"Hpotassiu" ratio and 6lood pressure e=ists. ' Salt added 6! t e indi5idual, "a! co"prise onl! &0G of t e older persons dail! salt inta:e. ' /ost salt is added to processed food. T e solution is to eat "ore fres foods and less processed foods. ' Increase potassiu" 6! eating apricots, prunes, orange @uice, potato, to"ato sauce, and 6ananas. ' Calciu", "agnesiu" ' calciu" controls 9TN in so"e people, "agnesiu" is related to cellular and tissue le5els of sodiu", potassiu", and calciu", and is considered to 6e an i"portant nutrient in controlling 9TN. Cere6ro5ascular disease: ' Pre5ention relies ea5il! on "aintaining nor"al 6lood pressure. ' /aintain ade<uate potassiu" inta:e. Cancer: ' $ietar! fat ' reduction appears to 6e t e "ost i"portant dietar! "eans of cancer pre5ention. 1 low fat diet see"s to pro5ide protection against 6reast, colon, and prostate cancer.

' $ietar! fi6er ' is protecti5e against colon and 6reast cancer, alt oug t e "ec anis" is not clear. ' 2eco""ended dietar! fi6er is at least %0 gra"s. ' +ot insolu6le and solu6le fi6er "a! a5e protecti5e roles. ' Calciu", 5ita"in $ ' in5estigated as a protecti5e factor against t e cellular !perproliferati5e c aracteristic of cancer. ' ,ita"ins, "inerals ' antio=idant 5ita"ins 1 and 6eta'carotene, 5it C,5it E, and t e trace "ineral seleniu" are 6eing studied as protecti5e factors against 5arious t!pes of cancer. T e antio=idants pro6a6l! function as sca5engers of free radicals, products of tissue o=idation t at cause cellular da"age. 7lucose intolerance: ' $efined as fasting 6lood glucose 6etween 113 and 1%( "gHdl. ' 1ppears to 6e re5ersi6le in so"e indi5iduals wit c anges in lifest!le. ' Weig t loss is essential in controlling glucose "eta6olis". ' Nutrients "ost specificall! in5ol5ed are car6o !drates, fi6er, and c ro"iu". ' Car6o !drates, fi6er ' decrease in si"ple car6o !drates and an increase in dietar! fi6er, especiall! solu6le, is effecti5e in nor"ali0ing "ild to "oderatel! ele5ated 6lood glucose le5els. ' C ro"iu" ' u"an studies a5e s own i"pro5e"ent of glucose intolerance wit c ro"iu" supple"entation. ,ision pro6le"s: ' /acular degeneration and cataracts, t e leading causes of 5ision pro6le"s in older adults "a! 6e pre5enta6le to so"e degree wit nutrition inter5ention. ' Jinc ' supple"entation s owed decreased degeneration. ' ,ita"ins ' ,ita"ins E, and C i"plicated as protecti5e against for"ation of cataracts. T e 6enefit appears to 6e due to t e antio=idant properties of t e 5ita"ins. I""une senescence: ' Protein, calories ' 2educed i""unoco"petence acco"panies 6ot acute and c ronic protein'calorie "alnutrition. 1de<uate inta:e of protein and calories can re5erse t is process and i"pro5e i""une function in so"e cases. ' Jinc, iron ' ad"inistration of t ese "inerals to correct deficiencies as 6een s own to restore i""une function. 9ig doses of 0inc can i"pair i""une function. 8steoporosis: ' Pre5ention is "ost effecti5e w en 6egun earl! in life. Certain nutritional strategies are appropriate for protecting older wo"en fro" t e effects of post"enopausal Bt!pe ICosteoporosis. ' Senile Bt!pe IIC osteoporosis affects 6ot genders. ' Calciu" ' +ecause few foods pro5ide ade<uate a"ounts of calciu" B "il:, !ogurtC, t e ig er calciu" inta:es "a! 6e difficult to ac ie5e 6! diet alone. ' ,ita"in $ ' Calciu" a6sorption depends on ade<uate 5it $ status. Poor 5it d status "a! 6e a ris: factor for 6one loss in t e elderl!. Supple"ents "a! 6e necessar! to

ensure ade<uate 5it $ inta:e. ' Trace ele"ents ' 6oron, "agnesiu", and "anganese a5e also 6een i"plicated in 6one loss.