CH-1-2 Nutrition, Food Choices, and Health – Wardlaw’s Contemporary Nutrition : Chapter Notes

This Document Contains Chapters 1 to 2 CHAPTER 1 NUTRITION, FOOD CHOICES, AND HEALTH OVERVIEW This introductory chapter provides an overview of the study of nutrition. Nutrients and their roles in the body are discussed. Energy and how it is measured are described. The Scientific Method is explained with particular focus given to its application in the study of nutrition. The typical North American diet is presented, along with methods the government uses to monitor consumption. Helpful math skills used in the study of nutrition are reviewed. U.S. health objectives included in Healthy People 2020 are briefly described. Recommendations for promoting healthy behaviors and lifestyles are also discussed. The Nutrition and Your Health section, "Eating Well in College," investigates common nutritional concerns faced by college students, including choosing foods, weight gain, alcohol and binge drinking, eating disorders, dietary concerns of vegetarians and student athletes, and tips for eating well on a budget. KEY TERMS Alcohol Amino acid Animal model Appetite Bond Cancer Carbohydrate Cardiovascular disease Case-control study Cell Chemical reaction Cholesterol Chronic Complex carbohydrate Control group Diabetes Double-blind study Electrolytes Enzyme Epidemiology Essential nutrient Fiber Genes Glucose Hunger Hypertension Hypothesis Inorganic Kilocalorie (kcal) Lipid Macronutrient Metabolism Micronutrient Mineral Nutrients Obesity Osteoporosis Phytochemical Placebo Protein Risk factor Satiety Scurvy Simple sugar Solvent Starch Stroke Theory Vitamin Water STUDENT LEARNING OUTCOMES Chapter 1 is designed to allow you to: 1.1 Describe how our food habits are affected by the flavor, texture, and appearance of food; routines and habits; early experiences and customs; advertising; nutrition and health concerns; restaurants; social changes; economics, and physiological processes affected by meal size and composition. 1.2 Identify diet and lifestyle factors that contribute to the 15 leading causes of death in North America. 1.3 Define the terms nutrition, carbohydrate, protein, lipid (fat), alcohol, vitamin, mineral, water, phytochemical, kilocalorie (kcal), and fiber. 1.4 Determine the total calories (kcal) of a food or diet using the weight and calorie content of the energy-yielding nutrients, convert English to metric units, and calculate percentages, such as percent of calories from fat in a diet. 1.5 Understand the scientific method as it is used in developing hypotheses and theories in the field of nutrition, including the determination of nutrient needs. 1.6 List the major characteristics of the North American diet, the food habits that often need improvement, and the key “Nutrition and Weight Status” objectives of the Healthy People 2020 report. 1.7 Describe a basic plan for health promotion and disease prevention and what to expect from good nutrition and a healthy lifestyle. 1.8 Identify food and nutrition issues relevant to college students. LECTURE OUTLINE 1.1 Why Do You Choose the Food You Eat? A. What Influences Your Food Choices? A mix of biological and social factors influence your food choices. (see Fig. 1-1) 1. Food flavor, texture, and appearance are the most important factors. 2. Early exposure to various people, places, and events 3. Routines and habits 4. Advertising and food marketing by food companies and/or restaurants (see Fig. 1-2) 5. Restaurant dining a. Larger portions, more calorie dense than home-cooked meals b. Federal regulations require health information on menus of some restaurants. 6. Time and convenience 7. Economics a. Food cost is second greatest reason why people choose their foods. b. Young adults and those with higher incomes spend the most on food. 8. Nutrition a. Well-educated, middle-class professionals make more health-related food choices. b. A greater percentage of women read food labels than men. B. Why Are You So Hungry? 1. Hunger is the physiological (internal) drive to eat. 2. Appetite is the psychological (external) influences that encourages us to eat, often in absence of hunger. 3. Satiety is the state in which there is no longer a desire to eat; a feeling of satisfaction. 1.2 How Is Nutrition Connected to Good Health? A. What Is Nutrition? 1. Science linking food to health and disease 2. Ingestion, digestion, absorption, transport, and excretion of food substances B. Nutrients Come from Food 1. Nutrients are substances found in food that provide energy, and are vital for growth and maintenance of body. 2. An essential nutrient is required by the body to meet its needs. The body cannot produce it, or produces it in too little quantity to meet its needs. 3. Essential nutrients must satisfy three criteria. a. Specific biological function of the nutrient in the body b. Omission of the nutrient leads to decline in biological functions c. Replacing the omitted nutrient before permanent damage occurs restores normal biological functions C. Why Study Nutrition? 1. Poor diet and sedentary lifestyle contribute to 7 of the 15 leading causes of death in the United States (see Fig. 1-3). 2. Combination of poor diet and lack of physical activity may be the second leading cause of death in the United States. 3. Obesity is considered second leading cause of preventable death in North America. 4. Table 1-1 presents glossary terms related to nutrition and chronic disease. 5. Figure 1-3 presents the fifteen leading causes of death in the United States. 1.3 What Are the Classes and Sources of Nutrients? A. Overview 1. Six classes of nutrients 2. Categorized by function (see Table 1-2) a. Provide calories to meet energy needs (i.e., energy-yielding nutrients; e.g., carbohydrates, lipids, and proteins) b. Promote growth, development, and maintenance (e.g., water, some vitamins and minerals, proteins, and lipids) c. Regulate body functions (e.g., water, some vitamins and minerals, proteins, and lipids) 3. Categorized by daily needs a. Macronutrients (e.g., carbohydrates, proteins, lipids, and water) b. Micronutrients (e.g., vitamins and minerals) B. Carbohydrates 1. Simple sugars (i.e., monosaccharides and disaccharides) 2. Complex carbohydrates (i.e., polysaccharides) a. starch - digestible b. fiber - indigestible 3. Primary source of energy (4kcal/g) C. Lipids (i.e., fats, oils) 1. Energy yield: 9 kilocalories/gram 2. Primary form of energy storage 3. Animal fats (butter and lard) are solid at room temperature 4. Plant oils are liquid at room temperature 5. Essential fatty acids a. Not produced by body, must be consumed in diet (essential nutrient) b. Roles in blood pressure regulation and synthesis/repair of cells c. Small amount required (4 Tbsp oil per day) D. Proteins 1. Functions a. Structural components of muscle and bone b. Blood components c. Body cell structure d. Enzymes e. Immune factors 2. Energy yield: 4 kilocalories/gram (limited use for this purpose) 3. Building blocks of proteins: amino acids a. Essential amino acids b. Non-essential amino acids 4. Dietary sources a. Animal b. Plant 5. Typical North American consumes up to 2 times daily requirement. E. Vitamins 1. Function: Enable chemical reactions 2. Energy yield: 0 kilocalories/gram 3. 13 Vitamins categorized by solubility a. Fat-soluble (vitamins A, D, E, and K) 1) Main sources: dairy products, nuts, seeds, oils, breakfast cereals 2) Not readily excreted from the body; some may become toxic b. Water-soluble (B vitamins and Vitamin C) 1) Main sources: fruits and vegetables 2) Easily destroyed by cooking 3) Most are readily excreted from the body F. Minerals 1. Inorganic – do not contain carbon 2. Simple molecules, not compounds 3. Not destroyed by cooking, but can leach into cooking water and be lost 4. Energy yield: 0 kilocalories/gram 5. Functions: role in nervous system, water balance, structural systems 6. 16 or more essential minerals 7. Categorized by body needs a. Major minerals (needed in amounts greater than 100 milligrams) b. Trace minerals (needed in amounts less than 100 milligrams) 8. Electrolytes – minerals that conduct electricity (sodium, potassium, and chloride) G. Water 1. Functions a. Solvent b. Lubricant c. Transport of nutrients and wastes d. Medium for temperature regulation and chemical processes 2. Human body is 60% water 3. Human needs a. Men: 13 cups/day b. Women: 9 cups/day 4. Sources a. Beverages (not just plain water) b. Foods c. By-product of metabolism H. Other Important Components in Food 1. Phytochemicals a. Found in fruits and vegetables b. Not essential nutrients c. Provides a variety of health benefits and may reduce risks for certain diseases d. Table 1-3 lists common food sources of some phytochemicals. 2. Sphingolipids and conjugated linoleic acid (CLA) a. Found in meat and dairy products b. Show some health benefits I. Sources of Nutrients 1. 500 grams (1 pound) protein, fat, and carbohydrate 2. 20 grams minerals (in total) 3. 300 milligrams vitamins (in total) 1.4 What Math Concepts Will Aid Your Study of Nutrition? A. Calories 1. Sources a. Carbohydrates (4 kilocalories/gram) b. Lipids (9 kilocalories/gram) c. Proteins (4 kilocalories/gram) d. Alcohol (7 kilocalories/gram; not an essential nutrient, therefore not required) 2. Most foods provide more than one calorie source 3. Energy (kcal) is used to a. Build new compounds b. Perform muscular movements c. Promote nerve transmission d. Maintain electrolyte balance within cells 4. Energy derived from food is measured in kilocalories a. 1 calorie = heat energy needed to raise the temperature of 1 gram of water 1°C b. 1 kilocalorie (Calorie) = 1000 calories (1 kcal) = heat energy needed to raise the temperature of 1000 grams of water 1°C c. On food labels, "calories" without a capital "C" means kcal. d. Figure 1-4 is a food label example of whole wheat bread. B. Calculating Calories 1. Use the 4-9-4 estimates to calculate calories from carbohydrate, fat, and protein. 2. Use the 4-9-4 estimates to determine what portion of total calorie intake is contributed by carbohydrate, fat, and protein. C. Percentages 1. Definition: Part of the total when the total represents 100 parts 2. Nutrition relevance: Used often when referring to menus and nutrient composition D. The Metric System 1. 1 ounce = 28 grams 2. 1 kilogram = 2.2 pounds 3. 1 millimeter is approximately the thickness of a dime 4. 1 inch = 2.54 centimeters 5. 1 quart = 0.946 liters 1.5 How Do We Know What We Know About Nutrition? A. The Scientific Method (see Fig. 1-5) 1. Develop hypotheses. a. Generated by observing natural phenomenon b. Generated by studying patterns among population groups 2. Controlled experiments are conducted to support or refute each hypothesis. a. Double-blind placebo controlled study is most rigorous type of experiment—neither researcher nor participant is aware of group assignment. 1) experimental group 2) control group b. Case-control studies involve comparisons made between individuals with and without certain conditions. 3. Data are gathered and evaluated. 4. Results can suggest a new set of questions. 5. Peer review and publication. 6. Additional follow-up studies will be conducted to confirm or refute the previous findings. B. Types of Experiments (see Fig. 1-6) 1. Human studies provide strongest evidence about relationship between nutrients and health. 2. Animal studies 3. Case-control studies 4. Epidemiological studies a. Study diet and disease patterns among populations b. Suggest hypotheses which then need to be tested by controlled experiments 1.6 What Is the Current State of the North American Diet and Health? A. Does Obesity Threaten Our Future? 1. Obesity is defined as having an excessive amount of body fat relative to lean tissue. 2. It is estimated that 35% of American adults are obese. 3. Two-thirds of adults and one-third of children are overweight or obese. 4. Robert Wood Johnson Foundation report: F as in Fat: How Obesity Threatens America's Future in 2012. (see Further Reading 19) a. Self reported, state-by-state obesity data from the CDC b. Twelve states have obesity rates above 30% c. Calls for national commitment to prevent obesity by 9%-14% by 2030. 5. Figure 1-7 illustrates the percentage of adults who are obese by state. 6. Obesity plays a role in chronic illnesses a. Heart disease b. Stroke c. High blood pressure d. High cholesterol e. Diabetes f. Arthritis g. Certain cancers 7. Problem: Consumption of too many energy dense, nutrient poor foods while living a sedentary lifestyle B. Assessing the Current North American Diet 1. National Health and Examination Survey (NHANES) data indicates: a. 15% of calories as proteins (Food and Nutrition Board recommends 10%-35%) b. 52% of calories as carbohydrates (FNB recommends 45%-65%) c. 33% of calories as fats (FNB recommends 20%-35%) 2. Majority (2/3) of protein intake for most North Americans is from animal sources 3. Approximately half of carbohydrates are from simple sugar sources, with the remaining coming from starches such as pastas, breads, and potatoes. 4. Approximately 60% of dietary fats are from animal sources. 5. Major contributors to an increase in energy observed in the U.S. diet include: a. Oils, shortening b. Meat c. Cheese d. Frozen desserts 6. Balance calorie intake with need and moderate portions a. Increase intake of nutrient rich fruits and vegetables b. Decrease intake of energy dense foods such as sugary beverages and fried foods C. Health Objectives for the United States for the Year 2020 1. Healthy People 2020 issued by the U.S. Department of Health and Human Services’ (DHHS) Public Health Service. a. Health objectives for our nation released every 10 years b. Contains more than 600 health objectives across 42 topic areas c. Outlines national standards to: 1) Eliminate health disparities 2) Improve access to health education and care 3) Strengthens public health services and efforts 2. Overarching goals a. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. b. Achieve health equity, eliminate disparities, and improve health of all groups. c. Create social and physical environments that promote good health for all. d. Promote quality of life, healthy development, and healthy behaviors across all life stages. 3. See www.HealthyPeople.gov for more information 4. Nutrition and Weight Status a. Specific to the area of nutrition b. Includes targeting individual behaviors c. Focuses on policies and environments that impact these behaviors in community settings d. Maintaining a healthy weight e. Supporting the benefits of eating a healthful diet 1) Consuming a variety of nutrient-dense foods within and across the food groups, especially whole grains, vegetables, fruits, low-fat or fat-free milk or milk products, and lean meats and other proteins. 2) Limiting intake of solid fats, cholesterol, added sugar, sodium (salt) and alcohol 3) Limiting intake of calories to meet needs to for calories f. Table 1-4 presents a list of the six categories of objectives for Healthy People 2020 Nutrition and Weight Status with 22 specific objectives. g. Table 1-5 presents a detailed sample of nine of the specific Nutrition and Weight Status Objectives and their target goals for 2020. 5. New topic areas included in Healthy People 2020 a. Highlights and focuses on changes in health needs of certain life stages 1) Early and middle childhood 2) Adolescence 3) Older adults b. Genomics 1) Investigating the relationship of nutrition and genetics 2) 9 of 10 of the leading causes of death have a genetic component 1.7 What Can You Expect from Good Nutrition and a Healthy Lifestyle? A. Healthy Weight 1. Recognize that nutrition is related to weight maintenance or gain, which can be associated with overweight/obesity and risks for chronic illnesses 2. Increased options for food as result of continual innovation by food manufacturers B. Longer, Healthier Lives 1. North Americans live longer and enjoy better health. 2. Decreased intake of animals fats and cholesterol combined with increased intake of fruits and vegetables will help improve health even more. C. The Total Diet 1. The position of the Academy of Nutrition and Dietetics states that "the total diet or overall pattern of food eaten is the most important focus of healthy eating." 2. Table 1-6 summarizes diet, physical activity, and lifestyle recommendations to promote health and prevent disease. 3. Other ways to promote health a. Get adequate amounts of sleep (7-9 hours per night). b. Consume adequate amounts of water and fluids (9-13 cups per day). c. Reduce your stress level. d. Use medications prudently. e. Abstain from illicit drug use. f. Maintain close relationships with others. g. Maintain a positive outlook on life. h. Consult regularly with primary care physician. Nutrition and Your Health: Eating Well in College A. Overview 1. Habits of college students fall short of recommendations for whole grains, vegetables, fruits, milk, and meat; include too much fats, sweets, and alcohol. 2. Health behaviors formed during young adulthood are likely to persist throughout life. B. Food Choices 1. Stress may negatively impact nutrition and activity habits. 2. Abundance of energy-dense, nutrient-poor food choices on college campuses 3. Meals are a time for socialization. C. Weight Control and the “Freshman Fifteen” 1. A recent study (see Further reading 21) of 7000 U.S. college students found that students gain 2.4-3.5 pounds during their first year away from home. a. Heavy beer consumption b. Working during college 2. Weight loss will improve short-term and long-term health. 3. Losing excess weight a. Set several, small goals b. Monitor foods and activities (Use interactive tools on www.ChooseMyPlate.gov). c. Gradual weight loss of 1–2 pounds per week (deficit of 500 kilocalories/day below needs) d. Eat a balanced breakfast e. Moderate use of alcohol and sugary beverages (including gourmet coffee beverages) f. Exercise 1) Enjoyable activities 2) Work out with a friend D. Alcohol and Binge Drinking 1. Five or more drinks in a row for men 2. Four or more drinks in a row for women 3. Moderate intake is two drinks a day or less for men and no more than one drink a day for women. 4. Two of five students on college campuses participates in binge drinking. 5. Alcohol-related health risks a. Accidents/injuries b. Unsafe sex and its consequences c. Long-term health problems d. Suicides e. Academic problems f. Legal troubles g. Alcohol abuse or dependence h. Weight gain 6. Thirty-one percent of college students meet criteria for alcohol use disorders. E. Eating Disorders 1. Thirty percent of college students are at risk of developing an eating disorder. 2. Short-term disordered eating patterns may progress to an eating disorder. 3. Food becomes the focus of emotional issues. 4. Risks a. Limited academic performance b. Loss of menstrual periods c. Thinning bones d. Gastrointestinal problems e. Kidney problems f. Heart abnormalities g. Death F. Choosing a Vegetarian Lifestyle 1. Plant-based diets can be a healthful lifestyle, but require appropriate planning. 2. Fortified breakfast cereals provide many vitamins and minerals. 3. Many vegetarian options available 4. Tips to optimize nutritional benefit of plant-based diets a. Choose baked, steamed, or stir-fried rather than deep-fried. b. Choose whole grains rather than refined carbohydrates. c. Consume foods fortified with vitamins and minerals. G. Fuel for Competition: Student Athletes 1. Increased calorie and nutrient needs. 2. Avoid severe calorie restriction – carbohydrate and fat supply energy to exercising muscles. 3. Emphasis on fluids – sports drinks are ideal for events lasting longer than 60 minutes. 4. Losing fluid intentionally is an unhealthy practice 5. Expensive supplements are not necessary H. Tips for Eating Well on a College Student’s Budget 1. Participate in a prepaid campus meal plan. 2. Planning ahead will save money and improve nutrient intake. 3. Never shop on an empty stomach. 4. Buy store brands. 5. Make use of canned and frozen fruits and vegetables and dry foods. 6. Purchase concentrated fruit juices. 7. Eggs and peanut butter are inexpensive sources of protein. BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE 1. Use the Rate Your Plate, Examine Your Eating Habits More Closely, activity at the end of Chapter 1. Have the students follow the instructions, and use it as an object for class discussion regarding their eating habits. A. Make sure they follow the assignment instructions closely because this one-day food record can be used for future activities. They should record all foods and beverages consumed and the serving sizes, in addition to the other data. To allow them to get a sense of serving sizes, bring in measuring cups and devices, and actually illustrate what 1 cup of cereal looks like in a bowl, as well as the serving sizes of other foods. Ask the class to try to eat simple foods during the day of record and to avoid complex mixtures. It can be difficult to break these complex mixtures into individual ingredients for analysis. B. Even though this is an end-of-the-chapter activity, it would be best if the food record were completed during the first week of class, so it can be used for subsequent activities. C. Instructors could require a three-day food record so it can be used for future activities. The data, at a later time, can be averaged for the three days to assess nutrient intake. 2. Use the Rate Your Plate, Observe the Supermarket Explosion, activity at the end of Chapter 1 to launch a discussion about new supermarket items. 3. Have students list the various kinds of restaurants in the campus area and tally how often they have frequented them. Do they use college or university food service? How often do they use vending machines? Why do they make the choices they do? What changes would they like to see made in the food and food service choices available? 4. Have students discuss their parents' food habits, both good and bad. How are the students' food habits similar to their parents'? How have their parents' food habits and attitudes affected their eating habits? 5. During the first couple of lectures, have students bring examples of nutrition topics in the popular press to class. Group the articles by syllabus topic and revisit them after students have read the appropriate chapter in the text. Have students form small groups to discuss and evaluate the topics in terms of what they learned about nutrition since the beginning of the course. 6. Have students make a list of five questions they have about food and nutrition. Collect the questions. The last week of the course hand back the questions. Have them divide up into groups and discuss whether they can answer their own questions. If some are left unanswered let them discuss possible answers in their groups. This will be a good way to review course material. CHAPTER 2 GUIDELINES FOR DESIGNING A HEALTHY DIET OVERVIEW This chapter explores components of healthy diet plans—those that will minimize risks of developing nutrition-related diseases. Three principles of a healthful diet (variety, proportionality, moderation) as well as nutrient and energy density are discussed. The purpose and key recommendations of the Dietary Guidelines and the 2008 Physical Activity Guidelines for Americans are explained. Tools for planning and evaluating dietary intake are discussed, including the Dietary Reference Intakes (DRI), the Dietary Guidelines, MyPlate.gov, the Mediterranean Diet, nutrient standards, and food labels. An overview of nutritional status and its assessment is provided. Suggestions are outlined to highlight the best approach to evaluate nutrition information. KEY TERMS Adequate intake (AI) Added sugars Anthropometric assessment Biochemical assessment Clinical assessment Dietary assessment Dietary Reference Intakes (DRIs) Dietary Guidelines for Americans Eating pattern Empty calories Environmental assessment Energy density Estimated Energy Requirement (EER) Functional foods Heart attack Malnutrition Megadose Nutrient density Nutritional state Overnutrition Recommended Dietary Allowance (RDA) Registered dietitian (R.D.) or registered dietitian nutritionist (R.D.N.) Solid fats Subclinical Symptom Undernutrition Tolerable Upper Intake Level (UL) STUDENT LEARNING OUTCOMES Chapter 2 is designed to allow you to: 2.1 Use variety, proportionality, and moderation, as well as nutrient and energy density, to develop a healthy eating plan. 2.2 List the purpose and key recommendations of the Dietary Guidelines and the 2008 Physical Activity Guidelines for Americans. 2.3 Design a meal that conforms to the MyPlate recommendations as well as the Mediterranean diet and/or other diet planning guides. 2.4 Describe the three states of nutritional health. 2.5 Outline the measurements used (ABCDEs) in nutritional assessment: Anthropometric, Biochemical, Clinical, Dietary, and Environmental status. 2.6 Describe the specific nutrient recommendations categories within the Dietary Reference Intakes. 2.7 Identify reliable sources of nutrition information. 2.8 Describe the components of the Nutrition Facts panel and the various health claims and label descriptors that are allowed. LECTURE OUTLINE 2.1 A Food Philosophy That Works A. Overview 1. Consume a variety of foods, balanced by a moderate intake of each food. 2. Emphasize a total diet pattern 3. Principles of variety, moderation, and proportionality B. Variety Means Eating Many Different Foods 1. Choose foods from all food groups and subgroups as no single food meets all nutrient needs. 2. Select foods from all of the food groups using MyPlate as a guide. a. Vegetables b. Fruit c. Grains d. Protein e. Dairy 3. Choosing a variety of foods, particularly from fruits and vegetables, provides benefits beyond meeting nutrient needs. a. Various phytochemicals are present in fruits and vegetables. 1) Some phytochemicals can help decrease cancer and other disease risk. 2) Table 2-1 provides tips for boosting the phytochemical content of the diet. 3) Foods, rather than supplements, can provide phytochemicals. b. Phytochemicals are considered functional foods. 1) Provide health benefits beyond those supplied by the traditional nutrients the food contains 2) Ex: Tomatoes contain the phytochemical lycopene which provides health benefits beyond those benefits provided by the vitamins/minerals found in a tomato. C. Proportionality Means Eating More of Nutrient-Dense Foods 1. Choose more nutrient-dense foods and beverages such as fruits, vegetables, whole grains, and fat-free or low-fat milk products. 2. Choose less often foods high in solid fats, sugars, cholesterol, salt, and alcohol. 3. Match energy intake with energy expenditure. 4. Nutrient density is characteristically used to determine a food's nutritional quality. (see Fig. 2-1) a. A food is more nutrient dense when its contribution to nutrient needs exceeds its contribution to calorie needs. b. Nutrient density is often used to describe a food relative to an individual nutrient. (ex: An orange is nutrient dense for Vitamin C). c. Nutrient density is particularly important for those who consume few calories (e.g., on a weight-loss diet, children, older adults). D. Moderation Refers Mostly to Portion Size 1. Do not overconsume any nutrients a. Moderate intake of animal fat, added sugars, cholesterol, salt, and alcohol. b. Avoid overconsumption of nutrients from supplements. 2. Energy density describes the calorie content of a food. a. Compare the calorie content with the weight of the food. 1) High energy density foods include nuts, fried food, cookies. 2) Low energy density foods promote satiety without high calorie content. b. Eating lower energy dense foods promotes satiety without contributing many calories. 1) People consume a constant weight of food at one time. 2) Low energy dense foods contain high amounts of water and fiber (e.g., fruits and vegetables). c. Carefully plan to include foods that are both nutrient and energy dense (i.e., peanut butter). d. Table 2-2 presents the energy density of some common foods. 2.2 Dietary and Physical Activity Guidelines A. Dietary Guidelines—the Basis for Menu Planning 1. The 2010 Dietary Guidelines for Americans provide nutrition and physical activity recommendations for all Americans 2 years of age and older. a. Published every five years by the USDA and U.S. Department of Health and Human Services (USDHHS) b. Message of calorie balance is a key component. c. New to 2010 Guidelines: recommendations for those at risk of developing chronic diseases d. Include 20 key recommendations (see Fig. 2-2) e. Three major goals 1) Balance calories with physical activity to manage weight. 2) Consume more of certain foods and nutrients, such as vegetables, fruits, whole grains, fat-free and low-fat dairy products, and seafood. 3) Consume fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains. 2. Balancing calories to manage weight a. Maintain and achieve a healthy weight. b. Figure 2-3 provides general estimations of calorie needs or you can estimate your caloric needs by using the online calculator at www.ChooseMyPlate.gov . 3. Foods and food components to reduce (see Fig. 2-2) a. Sodium (salt) b. Solid fats c. Added sugars d. Refined grains e. Reduce to or maintain moderate consumption of alcohol 4. Foods and nutrients to increase (see Fig. 2-2) a. Vegetables b. Fruits c. Whole grains d. Fat-free or low-fat milk and milk products e. Seafood f. Lean meats and poultry g. Eggs h. Beans and peas i. Nuts and seeds j. Plant oils 5. Figure 2-4 illustrates the inadequacies of the Typical American Diet in meeting the recommendations of Dietary Guidelines for specific nutrients. a. Calories from solid fats and added sugars (SoFAS) are a source of empty calories and consumed at 280% recommended limit. b. Fiber, potassium, Vitamin D, and calcium are nutrients consumed in inadequate amounts and are of greatest concern. 6. Building healthy eating patterns a. Individuals can find examples of healthy eating patterns by examining the Dietary Approaches to Stop Hypertension (DASH), USDA Food Patterns that accompany MyPlate, the Harvard Healthy Eating Plate, vegetarian eating patterns, and Mediterranean-style eating patterns. b. Include an abundance of vegetables and fruits, with emphasis on whole grains, moderate and varied intake of protein-rich foods, limited solid fats and added sugars (SoFAS), higher proportion of unsaturated fats compared to saturated fats, increased potassium intake, and lower sodium intake. 7. The Dietary Guidelines and you a. Dietary Guidelines provide typical adults with simple advice. b. Consider current state of health, differences in genetic background, and family history when planning your diet. c. Table 2-3 presents examples of recommended diet changes based on the Dietary Guidelines. B. Physical Activity Guidelines for Americans 1. U.S. Department of Health and Human Services (DHHS) issued the first Physical Activity Guidelines for Americans in 2008 to complement the Dietary Guidelines. 2. The main idea: regular physical activity for people of all ages will produce long-term health benefits 3. General Recommendations a. Adult recommendation: 150 minutes/wk of moderate-intensity physical activity. b. Children and adolescent recommendation: 60 minutes/day of physical activity c. Include both aerobic and strength training activities for optimal benefits d. Activities should be safe and enjoyable 4. Table 2-4 presents key physical activity recommendations from these guidelines. 2.3 MyPlate—a menu-planning tool A. Overview 1. MyPlate was released in 2011 and is a visual depiction that is based on the 2010 Dietary Guidelines for Americans. (see Fig. 2-5) 2. MyPlate replaced the previous visual representation of guidelines known as MyPyramid. 3. Dishing up MyPlate a. The MyPlate icon includes five food groups: 1) Fruits and vegetables which cover half of the plate 2) Grains which cover slightly more than one-fourth of the plate 3) Protein which cover the remaining portion of the plate 4) Dairy appears as a cup next to the plate b. There is not a separate group for fats or oils included in MyPlate. 4. Consumer health messages a. Simple, actionable health messages capture attention and achieve behavior change. b. ChooseMyPlate.gov provides three clear recommendations: 1) Balance Calories 2) Foods to increase 3) Foods to reduce 5. Daily food plans a. ChooseMyPlate.gov provides an interactive tool to estimate caloric need and provide a suggested food pattern based on age, gender, height, and weight. b. Table 2-5 presents the recommended MyPlate food-intake patterns. c. See Figure 2-6 for a description of what counts as a MyPlate serving. d. Figure 2-7 shows a convenient guide to estimate common serving size measurements. e. MyPlate recommends limits for empty calories from solid fats and added sugars (SoFAS) and sets allowances at a range of 120-600 kcal per day based on total energy needs. 6. Additional MyPlate resources a. There are several interactive tools available for consumers at ChooseMyPlate.gov that can assist individuals in making healthy choices. b. Nutrition education, sample menus and recipes, Food-A-Pedia, and SuperTracker tool 7. Menu planning with MyPlate a. Important considerations when using MyPlate to plan a menu 1) It is not intended for infants or children under 2 years of age. 2) Consume a variety of foods to obtain all nutrients needed. 3) There can be variation in the amount of nutrients and calories within each food group. 4) Choosing fat-free or low-fat dairy items allows for greater amounts of foods to be eaten from all groups. 5) Plant foods can also be good sources of proteins. 6) Focus on colorful fruits and vegetables to increase the nutritional quality of these choices. 7) Choose whole grain products over refined grains. 8) Include plant oils daily and fish at least twice a week. b. Table 2-6 presents the nutrient contribution of the MyPlate food groups. c. Table 2-7 illustrates an example of putting MyPlate into practice. 8. Limitations of MyPlate a. Does not provide information about the overall calories, serving sizes, or number of servings b. The MyPlate icon doesn't address the types of foods to choose within each food group. c. It focuses on plates at each mealtime but not the overall diet of individuals. d. Populations with poor diets may not easily obtain the messages from MyPlate using the internet. 9. How does your plate rate? a. Compare your overall intake to the recommendations detailed at ChooseMyPlate.gov and by using the SuperTracker tool. b. Compare your intake to the DRI and make the necessary changes to improve your food selections. B. The Mediterranean Diet Pyramid (see Fig. 2-9) 1. Diet patterns of the southern Mediterranean region are outlined in this eating pattern. 2. Mediterranean diet is associated with low rates of chronic disease and high life expectancy. 2.4 States of Nutritional Health (see Fig. 2-10) A. Desirable nutrition 1. Body tissues have enough of a nutrient to support normal metabolic function. 2. Achieved by consuming essential nutrients from variety of foods B. Undernutrition 1. Form of malnutrition in which nutrient intake does not meet nutrient needs 2. When nutrient levels fall sufficiently low, biochemical evidence appears but without outward symptoms (subclinical deficiency). 3. Over time, clinical symptoms of deficiency surface, often evident in skin, hair, nails, tongue, or eyes. C. Overnutrition 1. Form of malnutrition characterized by prolonged consumption of more nutrients than the body needs 2. Example: too much vitamin A can have negative effects during pregnancy 3. Excess calorie intake is most common in industrialized nations. 4. The difference between optimal and over consumption is the smallest for vitamin A, calcium, iron, and copper. 2.5 Measuring Your Nutritional State A. Analyzing Background Factors (see Table 2-8) 1. Family history 2. Medical history: disease states or treatments could affect nutrient status 3. Medications 4. Social history such as marital status or living conditions 5. Education level 6. Economic status: ability to purchase, transport, and cook food B. Assessing Nutritional Status Using the ABCDEs (see Table 2-8 and Fig. 2-11) 1. Anthropometric assessment: height, weight, skinfold thicknesses, and body circumferences 2. Biochemical assessment: measuring nutrients or by-products in the blood and other body fluids 3. Clinical assessment: looking for physical evidence (e.g., high blood pressure) 4. Dietary assessment: examining dietary intake 5. Environmental assessment: from background analysis C. Recognizing the Limitations of Nutritional Assessment 1. Clinical symptoms of nutrient status may take years to develop a. One may eat a diet high in saturated fat for many years before a heart attack occurs. b. One may have a calcium deficiency but it takes years for low bone density to appear. 2. Many signs are not specific to a nutrient deficiency (e.g., diarrhea, facial sores). D. Concern About the State of Your Nutritional Health Is Important 1. Those who recognize the importance of nutritional health are more apt to live a longer and vigorous life. 2. Healthy habits include: a. Consuming a healthy diet b. Maintaining a healthy weight c. Occasionally consuming alcohol in small amounts d. Exercising for at least 30 min/day e. Avoiding tobacco 2.6 Specific Nutrient Standards and Recommendations A. Overview 1. Dietary Reference Intakes (DRI) is the umbrella reference term that describes four standards for nutrient needs: Recommended Dietary Allowance (RDA), Adequate Intake (AI), Estimated Energy Requirement (EER), Tolerable Upper Intake Level (UL). 2. Development of DRI's is an ongoing effort between Food and Nutrition Board (FNB) and Institutes of Medicine. 3. Table 2-9 summarizes nutrient standards used in the United States and Canada. B. Recommended Dietary Allowance (RDA) 1. Daily amount of nutrient that meets the needs of 97% of all healthy individuals in a particular age and gender group 2. Intakes slightly above or below the RDA are of no concern 3. A significant deviation (70% below or 3X above) for an extended period can lead to deficiency or toxicity. C. Adequate intake (AI) 1. Established if there is not sufficient information on human needs to set an RDA 2. Derived from dietary intakes of people who appear to be maintaining nutritional health (no deficiency apparent) D. Estimated Energy Requirement (EER) 1. Not set higher than average need (as for vitamins and minerals) because this would lead to excess calories and weight gain 2. Takes into account age, gender, height, weight, and physical activity 3. Also accounts for additional needs during growth and lactation 4. Serves as a starting point for estimating calorie needs, as individual needs vary E. Tolerable Upper Intake Level (UL) 1. The highest amount of a nutrient that is unlikely to cause adverse health effects in the long run for most people 2. Usually seen with diets promoting excess intake of a limited variety of foods, many fortified foods, or megadoses of specific vitamins or minerals F. Daily Value 1. Generic standard used on food labels—usually reflects the highest RDA (or related nutrient standard) seen in various age and gender categories for the nutrient 2. Values based on consumption of 2000 kcal per day 3. Allows consumers to compare intake from a specific food to desirable (or maximum) intake levels G. How Should These Nutrient Standards Be Used? 1. Figure 2-12 illustrates how the various nutrient standards relate to each other and to risk for deficiency or toxicity. 2. The type of standard that is set depends on the quality of available evidence. 3. Diet plans should strive to meet the RDA or AI without exceeding the UL. 4. AI should not be used alone to evaluate individual needs. 5. Daily Values, which appear on food labels, serve as guidelines for comparison of nutrient content of foods to approximate human needs; set at or close to RDA value. 2.7 Evaluating Nutrition Information A. Suggestions to Make Healthful and Logical Nutrition Decisions 1. Apply basic nutrition principles you’ve learned to any nutrition claim. 2. Examine the background and scientific credentials of the individual, organization, or publication making any nutrition claim. 3. Be wary of health-related nutrition claims that ignore possible disadvantages, sound too good to be true, seem biased against the medical community, or are touted as a secret breakthrough. 4. Note the size and duration of studies cited in a nutrition claim. 5. Beware of marketing hype. 6. Expect a nutrition professional to question your medical background and habits, tailor a diet plan to your needs, follow up, involve family members, and work with other health professionals. 7. Avoid supplement megadoses. 8. Examine product labels carefully. B. Consult Registered Dietitian (R.D.) C. Consult Reputable Websites 1. www.eatright.org (American Academy of Nutrition and Dietetics) 2. acsh.org (American Council on Science and Health) 3. www.quackwatch.org 4. www.ncahf.org (National Council Against Health Fraud) 5. http://ods.od.nih.gov/ (National Institutes of Health, Office of Dietary Supplements) 6. www.fda.gov (US Food and Drug Administration) Nutrition and Your Health: Food Labels and Diet Planning A. Overview 1. Labels must include: product name, manufacturer name and address, amount of product in package, ingredients in descending order by weight. 2. Monitored by FDA 3. Nutrition Facts panel (see Fig. 2-13) must include: a. Total calories (kcal) b. Calories from fat c. Total fat d. Saturated fat e. Trans fat f. Cholesterol g. Sodium h. Total carbohydrate i. Fiber j. Sugars k. Protein l. Vitamin A m. Vitamin C n. Calcium o. Iron p. Monounsaturated or polyunsaturated fats, potassium and others, if health claims are made about them 4. Serving sizes must be consistent among similar foods but are not necessarily the same as what is recommended by MyPlate. 5. Food Claims listed on package must follow legal definitions (see Table 2-10 for list of definitions for nutrient claims allowed on food labels). 6. Daily Values are often listed for fat, cholesterol, and carbohydrate. B. Proposed Changes to Nutrition Labels 1. FDA proposed changes to Nutrition Facts Panel in February 2014. a. Update the Daily Values for various nutrients b. More realistic serving size information will reflect what is typically consumed in one sitting. c. Calorie amount printed in larger size than other information d. Two columns listed on larger packages to show information for serving size as well as package as a whole e. Additions include "added sugars," potassium, and Vitamin D amounts. f. Calories from fat will no longer be included. 2. Changes will take up to 2 years to implement once proposals are approved. See http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm387114.htm. C. Diet Planning with Labels 1. Use Daily Values to compare foods on nutrients. 2. Labels are helpful in identifying which foods are nutrient dense and energy dense. 3. Individuals who read Nutrition Facts when shopping for food report healthier nutrient consumption than those who do not. D. Exceptions to Food Labeling 1. Fresh fruits, vegetables, and fish are not required to have Nutrition Facts labels. 2. Because protein deficiency is rare in the United States, % Daily Value for protein is not required for products designed for people 4 years or older. 3. If % Daily Value is included, the product must be analyzed for protein quality. E. Health Claims on Food Labels 1. FDA permits some health claims with restrictions. 2. Four categories for claims on foods a. Health claims—closely regulated by FDA b. Preliminary health claims—regulated by FDA but evidence may be scant for the claim c. Nutrient claims—closely regulated by FDA (review Table 2-10) d. Structure/function claims—these are not FDA-approved or necessarily valid 3. FDA limits health messages to instances in which there is significant scientific agreement that a relationship exists between the nutrient and the disease. 4. Current allowed claims a. A diet with enough calcium and vitamin D and a reduced risk of osteoporosis b. A diet low in total fat and reduced risk of some cancers c. A diet low in saturated fat and cholesterol and a reduced risk of cardiovascular disease d. A diet rich in fiber and a reduced risk of some cancers e. A diet adequate in the synthetic form of the vitamin folate and reduced risk of neural tube defects f. Use of sugarless gum and reduced risk of tooth decay g. A diet rich in fruits, vegetables, and grain products that contain fiber and reduced risk of cardiovascular disease. Oats and Psyllium can be singled out in reducing risk of cardiovascular disease when statement also includes that the diet should be low in saturated fat and cholesterol. h. A diet rich in whole grain foods and other plant foods, as well as low in fat, saturated fat, and cholesterol, and a reduced risk of cardiovascular disease and certain cancers i. A diet low in saturated fat and cholesterol that also includes 25 grams of soy protein and a reduced risk of cardiovascular disease j. Fatty acids from oils present in fish and a reduced risk of cardiovascular disease k. Margarines containing plant stanols and sterols and a reduced risk of cardiovascular disease prevention 5. A health claim must meet two general requirements before it can be made for a food product. a. Must be a "good source" (before fortification) of fiber, protein, vitamin A, vitamin C, calcium, or iron b. Single serving cannot contain more than 13 grams of fat, 4 grams of saturated fat, 60 milligrams of cholesterol, or 480 milligrams of sodium 6. Qualified health claims are permitted when there is emerging evidence for a relationship between a food, food component, or dietary supplement and a reduced risk of a disease or health-related condition. BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE 1. Have students complete the Rate Your Plate activities, "Does Your Diet Compare to MyPlate?", “Are You Putting Health Advice into Practice?” and “Applying the Nutrition Facts Label to Your Daily Food Choices”. In this activity, students will use the dietary record they kept as suggested in Chapter 1 activities. Having students complete and analyze a three-day food record would provide a more accurate nutrition assessment. Students should hold on to this assessment for future use. 2. Ask students to select nutrition labels from four food products they consume regularly and to calculate the actual amount or percent of RDA of selected nutrients for their age and gender group provided by these products. 3. Provide students with a sample of a day's food intake. Make sure it is high in fat, sodium, simple sugars, and low in fruits and vegetables. Ask students to make changes in this menu to comply with the Dietary Guidelines. 4. People often have difficulty accurately estimating portion/serving sizes of foods they eat. To help students with this, have them estimate food portions in class. You can do this by bringing to class samples of commonly consumed foods, various-sized glasses, bowls, measuring cups, measuring spoons, and a food scale if one is available. Examples of food to bring: puffed rice, Grape Nuts, cooked pasta, bagel or English muffin, chips, peanut butter, shelled sunflower seeds, raisins, orange juice, grape juice, mayonnaise, and some type of salad dressing. Pick and choose students to estimate a portion size using only the bowls and glasses provided. Keep the measuring cups and spoons, as well as the food scale hidden during this phase of the activity. Once portion sizes have been estimated by the students, show them, using measuring cups, measuring spoons, and the food scale, how accurate portion sizes look. They will be amazed. At the same time, discuss how to record food portions, what could happen to one's health when portion sizes are either overestimated or underestimated, how the Food Guide Pyramid and Exchange System differ in serving sizes, and how relatively easy nutrient needs can be met by consuming foods. 5. Assign students the task of visiting the web site, http://www.dietitian.com/calcbody.php, to complete the Healthy Body Calculator. Discuss the various factors this site uses to assess a “healthy body.” How should individuals interpret their results? Instructor Manual for Wardlaw's Contemporary Nutrition Anne M. Smith , Angela L. Collene 9780078021374, 9781260092189