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turnover and risk for osteoporosis (Khosla et al., 1997). Adequate vitamin D intake in this population is important to reduce secondary hyperparathy-roidism and its attendant effects on bone turnover (Gennari, 2001).

Low Level of Physical Activity

Because of their disability or for other reasons, adults attending day care may be more sedentary than the general population. An analysis of data from the Behavioral Risk Factor Surveillance System found that noninstitutionalized adults with disability do not meet basic recommendations for physical activity according to recommendations from the Centers for Disease Control and Prevention and the American College of Sports Medicine (Boslaugh and Andresen, 2006). Messent et al. (1999) identified several barriers to activity encountered by individuals with learning disabilities. These included “unclear policy guidelines in residential and day service provision together with resourcing, transport and staffing constraints; participant income and expenditure; and limited options for physically active community leisure” (p. 409). An increase in physical activity may improve appetite and allow the consumption of additional food without leading to weight gain.

Impact of Chronic Disease

Any chronic disease may affect an individual’s nutrient needs or otherwise have an impact on nutritional status. Dietary modifications, which are described briefly below, may be needed to support health, and medications may affect dietary intake or lead to drug-nutrient interactions. Conditions that may require dietary modifications include obesity, frailty, hypertension, type 2 diabetes, and heart disease. Adequate nutrition and good dietary quality for individuals with these conditions may reduce morbidity and mortality.

Obesity is associated with disability among older adults (Houston et al., 2009). Weight gain may contribute to disability by making it more difficult to maintain activity levels and mobility (Rolland et al., 2009; Zamboni et al., 2008). Disability has been associated with a myriad of syndromes including malnutrition, inflammatory disease (especially in persons with multiple chronic conditions), and functional dependency (Becker, 1994; Topinková, 2008). For these reasons, among others, it is especially important for the meals and snacks provided to adults in day care to support healthy weight while providing adequate levels of nutrients.

Modified Diets

In many cases, adults with chronic disease may be prescribed a special diet. Some larger adult day care centers have access to a professional

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