Nutrition Overview

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Nutrition Overview
Lynn Thomas, DrPH, RD, CNSD
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http//nutrition.med.sc.edu
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A Little History

• Hippocrates
• Recommended exercise and diet
• Eat once a day
• Dilute all wine

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Medicine in the 16th Century

• Doctors monitored daily habits
• Doctors advised patients on food and drink
  choices
• Used herbs as medicines

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Nutrition Science

• 1913 Link between CHOL, animal fats, and
  arteriosclerosis found
• 1915 Link between Maize diet and pellagra
• 1918 Cod liver oil used to cure rickets
• 1921 Iodized salt used to prevent goiter
• 1922 Insulin developed

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Health Care

• 15 illnesses account for 56 of health care cost
  increases in the last decade
• Top 5 account for 33 of total increase
• Heart disease
• Pulmonary conditions
• Mental disorders
• Cancer
• Hypertension

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Obesity Trends Among U.S. AdultsBRFSS, 1990,
1995, 2005
(BMI ?30, or about 30 lbs overweight for 54
person)
1995
1990
2005
No Data lt10 1014
1519 2024 2529
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Obesity

• Raises risk
• heart disease
• diabetes
• nine types of cancer in various degrees
• Colon
• Breast and Uterine
• Kidney and Liver
• Esophageal and Stomach
• Pancreatic
• Gallbladder

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Food Insecurity

• gt 38 million people
• Poor dietary intake
• Questionable nutritional status
• Chronic diseases
• Substandard academic achievement
• Refer to community, state, and local programs
• Harvest Hope

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Data Gathering

• National Health and Nutrition Examination Survey
• Population based
• Health and nutrition status
• Data sets the health indices for
• Blood pressures
• Cholesterol levels
• Weight ranges

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Dietary Guidelines

• Issued jointly by USDA and USHHS
• Updated every 5 years
• Latest edition was released January 2005
• Promotes health and disease prevention
• Persons aged 2 and older

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Key Recommendations

• Consume a variety of nutrient dense foods and
  beverages within and among the basic food groups
  while choosing foods that limit the intake of
  saturated and trans fats, cholesterol, added
  sugars, salt, and alcohol.
• Meet recommended intakes within energy needs by
  adopting a balanced eating pattern, such as the
  USDA Food Guide or the DASH Eating Plan

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Key Recommendations

• To maintain body weight in a healthy range,
  balance calories from foods and beverages with
  calories expended.
• To prevent gradual weight gain over time, make
  small decreases in food and beverage calories and
  increase physical activity.

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Key Recommendations

• Engage in regular physical activity and reduce
  sedentary activities to promote health,
  psychological well-being, and a healthy body
  weight.
• Achieve physical fitness by including
  cardiovascular conditioning, stretching exercises
  for flexibility, and resistance exercises or
  calisthenics for muscle strength and endurance.
• There are additional recommendations for
  macronutrients, alcoholic beverages, and food
  safety.

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Special Considerations

• Adolescent females and women of childbearing age
  iron and folic acid
• Persons over age 50 vitamin B12
• Elders, persons with dark skin, and any one not
  exposed to sufficient UVB radiation vitamin D
• www.health.gov/dietaryguidelines

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Presentation Scenario

• You are doing a community presentation and are
  talking about the 2005 Dietary Guidelines. One
  of the changes has to do with physical activity
  recommendations. You explain that everyone needs
  to exercise most days of the week. For how long?

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Working OFF Lunch

• Sleeping 1.2 kcal/min
• Desk Work 1.3-1.5 kcal/min
• Talking 1.8 kcal/min
• Walking 5.6-7.0 kcal/min
• Running 10.0 kcal/min
  (12 minute mile)
• for 150 person

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Food Guidance System

• Guide to daily food choices
• Personalized approach to healthy eating
• Different guidance categories
• Activity
• Moderation and variety
• Personalization (downloadable calorie levels)

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History of USDAs Food Guidance
Food for Young Children
1992
1940s
1970s
1916
2005
1950s-1960s
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Food Groups are Color Coded
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Message Variety

• In the Dietary Guidelines
• Consume a variety of nutrient-dense foods and
  beverages within and among the basic food groups.
• In MyPyramid graphic
• Color bands represent that all food groups are
  needed each day for health.

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Message Proportionality

• In the Dietary Guidelines
• Adopt a balanced eating pattern.
• Sufficient amount of fruits and vegetables,
• 3 or more ounce equivalents of whole-grain
  products per day
• 3 cup equivalents per day of fat-free or low-fat
  milk or milk products.
• In MyPyramid graphic
• Differing widths of the color bands suggest
  about how much food should be eaten from each
  group.

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Message Moderation

• In the Dietary Guidelines
• Limit intake of saturated and trans fats, and
  choose products low in these fats.
• Make choices of meat, poultry, dry beans, and
  milk products that are lean, low-fat, or
  fat-free.
• Choose and prepare foods and beverages with
  little added sugars or calorie sweeteners.
• In MyPyramid graphic
• Food group bands narrow from
• bottom to top suggesting to eat
• nutrient-dense forms of foods.

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• Food portion
• sizes have
• changed
• over the past
• 20 years.

Slides marked by are adapted from
Portion Distortion by the National Heart, Lung
and Blood Institute at http//hin.nhlbi.nih.gov/po
rtion
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• Typical American Portions
• 2 cups cooked pasta
• 1 bagel (5 to 6 inch diameter)
• 1/4 chicken
• Large order (1 to 2 cups) French fries
• Big bowl (1 to 2 cups) chili with beans
• Large green salad (2 to 3 cups greens)

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Todays Larger Portions Add Up to Extra Pounds

• 100 extra
• calories per day

10-pound weight gain per year
Maintaining a healthy weight is a balancing
act Calories in Calories out (as exercise)
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Message Physical Activity

• In the Dietary Guidelines
• Engage in regular physical activity and reduce
  sedentary activities to promote health,
  psychological well-being, and a healthy body
  weight.
• In MyPyramid graphic
• Steps and person on them symbolize that physical
  activity should be a part of everyday healthy
  living.

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Print materials Mini Poster
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Office Scenario

• A twenty-six year old male patient is asking
  about eating a healthy diet. He is already
  starting the exercise program that you
  recommended at the last visit. What are your
  recommendations based on the food guidance
  system.

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Other Pyramids

• The first USDA pyramid can still be used for
  general counseling.
• Various organizations use the pyramid to depict
  other approaches to healthy eating.

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Food Guide Pyramid
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Food Guide Pyramid

• Guide to daily food choices
• Can be used for several kinds of modified diets.
• Smaller number of servings
  1600 kcalories
• Larger 2800 kcalories

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Philippines
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Older Adults
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Office Scenario

• A nineteen year old female is at a healthy
  weight. She is in for work up of fatigue with
  possible anemia. You find out that she is a
  strict vegetarian. What vitamins and minerals
  might be missing in her diet?

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Vegetarians

• Vegans do not eat any animal products.
• Fruitarians eat only fruit, nuts, honey, and
  olive oil.
• Lactovegetarians use milk and milk products in
  their diet.

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Vegetarians

• Ovovegetarians use eggs as a source of protein.
• Lacto-ovovegetarians use both milk products and
  eggs.
• Possible diet deficiencies calcium, iron,
  B12,and zinc.

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Office Scenario

• You are talking to one of your patients about
  lowering her intake of fats and saturated fats.
  You tell her to start reading the nutrition facts
  label. What new information related to fat is on
  the label?

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Updated Nutrition Facts Label
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Functional Foods

• Products marketed as foods enriched with
  substances known or assumed to be associated with
  health benefits
• OJ with calcium (good)
• St.Johns Wort Tortilla Chips (questionable)
• Kava candy bars (no, no)

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FDA Approved Health Claims

• Function claims- active bacteria
• Presence of a nutrient at a specified level-100
  of daily vitamin C
• Health claims- oat bran helps reduce serum
  cholesterol levels.
• Legal definitions for organic foods- at least 95
  organic ingredients or fed with organic feed

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Organic

• You are at the grocery store. You are buying
  spinach. There are several varieties. Which
  package label means the spinach is at least 95
  organic?

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Newspaper Article

• You are being interviewed by the local paper.
  They ask you to make a general (one size fits
  all) recommendation about herbal and dietary
  supplements. What do you tell them?

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Disease Prevention

• Special supplements-again keep up with the
  research. The pendulum is swinging in the
  direction of food once again.
• Antioxidants
• Folic acid
• Beta-carotene
• Vitamin C
• Vitamin E
• Fatty acids

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Labels on Supplements

• New labels required
• Term dietary supplement must be used
• serving size
• calories
• complete list of ingredients with common names
• if herbal part of plant used and how much is in
  each capsule

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Herbs

• Herbs not magical, but can have some
  benefit-important to keep up with the research.
• Common herbs Aloe
• Ginger Black Cohosh
• Cranberries Gingko
• Chamomile Ginseng
• Witch Hazel St. Johns Wort
• Echinacea Feverfew

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Drug Interactions

• Warfarin ginseng, gingko, garlic, ginger,
  feverfew, dong quai, chamomile
• Antidepressants St Johns Wort, gingko
• Benzodiazephines valerian, kava, nettle, sage

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Major Health Targets

• Weight reduction aids
• Heart homocysteine, soy, omega-3 fatty acids,
  stanols, whey proteins
• Womens Health issues menopause relief,
  osteoporosis, and breast cancer
• Children New nutraceutical market

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Office Scenario

• A patient ( 45 year old male with history of
  hypertension) tells you he has quit using his
  blood pressure medicine. He is now drinking
  mistletoe tea. How do you address this?

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Hypertension

• Increases of 8 percent last decade
• Lifestyle changes recommended
• Losing excess weight
• Being physically active
• Limiting alcoholic beverages
• Following heart health eating plan
• Including reducing intake of salt and other
  forms of sodium

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Medical Student Scenario
You have an important morning class at which you
will make a presentation. Youre keyed up and
nervous. Should you eat? And if so, what should
you eat?
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Medical Student Scenario
The only time you have for breakfast is in the
car on the way to school. What kinds of foods
will keep you going when you dont have time to
stop to eat?
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Medical Student Scenario
Around 300 or 400 each afternoon, you have an
energy lag. Its your lowest point of the day,
but you have to keep you energy up a few hours
more. What can you eat for a pick-me-up?
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MedicalStudent Scenario

• You have a meeting after work.
• What should you have for dinner to keep your
  brain working past the time is usually gets
  burned out?

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Health Promotion

• Be Well Informed
• Discriminate between fact fiction
• Who and what, when, where, why
• Combat Nutrition Misinformation
• Learn about reliable nutrition resources