Nutrition Overview

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Nutrition Overview
Lynn Thomas, DrPH, RD, CNSD
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Medicine in the 16th Century

• Doctors monitored daily habits
• Doctors advised patients on food and drink
  choices
• Foods classed as Dry or Wet, Hot and Cold
• Assigned degrees of heat, etc.

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Food Classes

• Dry-Cold
• Root vegetables
• Dried beans
• Dry-Hot
• Meats
• Peppers
• Cinnamon and Cumin

• Wet-Cold
• Leafy green vegetables
• Fish
• Squash and Melons
• Wet-Hot
• Milk
• Ginger,Onions
• Sugar, Almonds
• Chicken

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Examples

• Elderly thought to be cold and dry
• Encouraged to eat warm, moist foods
• Southerners believed to be more hot blooded than
  northern folks
• Encouraged to eat cold, wet foods to calm them
  down

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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

• 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 Preparation

• Took many hours
• Hard Work-Wood stoves, outside water, everything
  fresh from the farm
• Persons needed to have higher kcal meals to
  maintain kcal expenditure from farming and labor

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Common American Foods

• 1951 cake mix
• 1952 Sugar Frosted Flakes
• 1957 sweet n low
• 1958 Tang
• 1963 Tab
• 1966 Cool Whip
• 1968 Pringles
• 1981 TCBY frozen yogurt
• 1984 Diet Coke
• 1996 Fat-free Pringles

• 1875 Choc Milk
• 1876 Heniz Ketchup
• 1897 Jell-O
• 1907 Hersheys Kisses
• 1916 All Bran
• 1921 Wonder Bread
• 1930 Birds Eye Frozen Foods
• 1934 Ritz Crackers
• 1941 Cheerios
• 1946 instant coffee

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Data Gathering

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

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Food Insecurity

• 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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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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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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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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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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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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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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Additional Messages in the MyPyramid GraphicTo
foster implementation

• Personalization
• The name MyPyramid suggests an individual
  approach.
• The person climbing the steps mentally links
  each viewer to the image.
• Gradual Improvement
• The slogan Steps to a Healthier You suggests
  that improvement should happen in stages, over
  time.

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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
• Changes pending

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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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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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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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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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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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Disease Prevention

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

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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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Health Promotion

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