Ch. 2: Designing a Healthy Eating Pattern
malnutrition
Failing health that results from chronic dietary patterns that do not coincide with nutritional needs.; umbrella term that refers to both overnutrition and undernutrition which are neither conducive to good health; also it is possible to be both overnourished (consume excess calories) and undernourished (consume too few essential vitamins and minerals) at the same time
Qualified health claims
FDA's Consumer Health Information for Better Nutrition Initiative also allows the use of qualified health claims when there is emerging evidence for a relationship between a food, food component, or dietary supplement and reduced risk of a disease or health-related condition. In this case, the evidence is not well enough established to meet the significant scientific agreement standard required for an FDA-authorized health claim.
environmental assessment
Includes details about living conditions, education level, and the ability of the person to purchase, transport, and cook food. The person's weekly budget for food purchases is also a key factor to consider. environmental assessment (from the background information) provides further details about the living conditions, education level, and ability to access and prepare foods needed to maintain optimal health.
megadose
Large intake of a nutrient beyond estimates of needs or what would be found in a balanced diet; 2 to 10 times human needs is typically a starting point. Avoid practitioners who prescribe megadoses of vitamin and mineral supplements for everyone.
heart attack
Rapid fall in heart function caused by reduced blood flow through the heart's blood vessels. Often part of the heart dies in the process. Technically called a myocardial infarction when the blood vessels become sufficiently blocked by cholesterol and other materials, chest pain during physical activity or a heart attack may occur.
other requirements to make a health claim
before a health claim can be made for a food product, it must meet two general requirements. First, the food must be a "good source" (before any fortification) of fiber, protein, vitamin A, vitamin C, calcium, or iron. (The legal definition of "good source" appears in Table 2-11). Second, a single serving of the food product cannot contain more than 13 grams of fat, 4 grams of saturated fat, 60 milligrams of cholesterol, or 480 milligrams of sodium. If a food exceeds any one of these requirements, no health claim can be made for it, despite its other nutritional qualities.
myplate limits:
sets limits for empty calories, which come from saturated fats and added sugars. Saturated fats and added sugars add calories to the diet but contribute few nutrients. Saturated fats are solid at room temperature and include butter, beef fat, and shortening. Some saturated fats, such as the marbling in a ribeye steak and the fat in milk (Fig. 2-8), are naturally present in foods. Others, such as the shortening used to make a flaky croissant, are added during food processing or preparation. Added sugars include sugars and syrups that are added to foods during processing or preparation. Examples of foods that are major contributors of empty calories in the American dietary pattern are cakes, cookies, pastries, soft drinks, energy drinks, cheese, pizza, ice cream, and processed meats. The MyPlate Plan also makes some allowance for empty calories throughout the day; depending on total energy needs, allowances range from 150 kcal to 610 kcal per day.
subclinical
stage of a disease or disorder not severe enough to produce symptoms that can be detected or diagnosed
undernutrition
Failing health that results from a long-standing dietary intake that is suboptimal and does not meet nutritional needs. as stores are exhausted, health begins to decline. Many nutrients are in high demand due to constant cell loss and regeneration in the body, such as in the gastrointestinal tract. For this reason, the stores of certain nutrients, including many of the B vitamins, are exhausted rapidly and therefore must be replenished regularly. - In addition, some women in North America do not consume sufficient iron to compensate for monthly menstrual losses and eventually deplete their iron stores
symptoms:
A change in health status noted by the person with the problem, such as stomach pain
clinical assessment
Examination of general appearance of skin, eyes, and tongue; evidence of: rapid hair loss; sense of touch; and ability to cough and walk. often necessary to determine physical evidence (e.g., high blood pressure) of diet-related diseases or deficiencies.
the myplate icon food groups:
*Dietary Guidelines that Americans need to increase the relative proportions of fruits, vegetables, whole grains, and fat-free or low-fat dairy products while simultaneously decreasing consumption of refined grains and high-fat meats. -myplate: the visual representation of the Dietary Guidelines, was released as the leading depiction of healthy eating for Americans; visual-meal place setting The MyPlate icon includes five food groups: Fruits and vegetables cover half of the plate. These foods are dense sources of nutrients and health-promoting phytochemicals despite their low calorie contents. Grains occupy slightly more than one-fourth of the plate. The message to make at least half your grains whole is stressed throughout accompanying consumer-education materials. The remaining space on the plate is reserved for sources of protein. Specifically, the Dietary Guidelines recommend a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products. A cup of dairy appears next to the plate. Depending on personalized calorie recommendations, users should have 2 to 3 cups per day of low-fat or fat-free dairy products or other rich sources of calcium. MyPlate does not display a separate group for fats and oils, as they are mostly incorporated into other foods. MyPlate food guide recommends limiting solid fats and focusing instead on plant oils, which are sources of essential fatty acids and vitamin E.
limitations of myplate
, it does not immediately provide information about overall calories, serving sizes, or number of servings to choose from each food group. However, many of these details will vary by person. does not address the types of foods to choose within each food group. Making appropriate food choices for weight management and prevention of diet-related chronic diseases requires consumers to have some nutrition knowledge. Fortunately, public health messages and online content related to MyPlate are available to educate Americans. shows how to build a healthy plate at mealtimes, but it does not adequately address the total diet, which in reality includes many snacks between meals. is possible that the people who need it most will overlook the MyPlate message. Educated consumers with access to interactive MyPlate tools likely already comply with many of the Dietary Guidelines. Populations with poor diets may be unlikely or unable to access online materials to find their personalized MyPlate Plan. STRENGTH: The strength of MyPlate lies in its simplicity. It conveys the major messages that are needed when shopping, cooking, and eating
phytochemicals
. Current multivitamin and mineral supplements contain few or none of these beneficial plant chemicals, so it is important to consume a wide variety of whole, plant-based foods to obtain these health benefits. added bonus of dietary variety, especially within the fruit and vegetable groups, is the inclusion of a rich supply of phytochemicals. t it is more important to focus on whole foods and eating patterns rather than individual nutrients or phytochemicals to successfully reduce disease risk.2
menu planning with myplate:
. To achieve optimal nutrition, remember the following points when using MyPlate to plan your daily menus: The guide does not apply to infants or children under 2 years of age. Daily food plans for children from ages 2 to 8 are based on average height and weight for age and sex. Variety is a key to successful implementation of MyPlate. There is no single, perfect food that is absolutely essential to good nutrition. Each food is rich in some nutrients but deficient in at least one essential nutrient. Likewise, no food group is more important than another; each food group makes an important, distinctive contribution to nutritional intake (Table 2-6). Choose foods from each food group and also choose different foods within each food group foods within a group may vary widely with respect to nutrients and calories. Choose primarily low-fat and fat-free items from the dairy group. By reducing calorie intake in this way, you can select more items from other food groups. If milk causes intestinal gas and bloating, emphasize yogurt and cheese Include plant foods that are good sources of protein, such as beans, seeds, and nuts, at least several times a week because many are rich in vitamins (such as vitamin E), minerals (such as magnesium), and fiber. For vegetables and fruits, try to include a dark-green or orange vegetable for vitamin A, and a vitamin C-rich fruit, such as an orange, every day. Do not focus primarily on potatoes (e.g., French fries) for your vegetable choices. Surveys show that fewer than 5% of adults eat a full serving of a dark-green vegetable on any given day. Increased consumption of these foods is important because they contribute vitamins, minerals, fiber, and phytochemicals. Choose whole grain varieties of breads, cereals, rice, and pasta because they contribute vitamin E and fiber. Include some unsaturated plant oils on a daily basis, such as those in salad dressing, and eat fish at least twice a week. This supplies you with health-promoting essential fatty acids.
chapter 2 summary
2.1 A healthy eating plan is based on consuming a variety of foods balanced by a moderate intake of each food and will minimize the risk of developing nutrition-related diseases. Balance is eating foods with greater nutrient density and reflects the nutrient content of a food in relation to its calorie content. Nutrient-dense foods are relatively rich in nutrients in comparison with calorie content. Energy density of a food is determined by comparing calorie content with the weight of food. A food rich in calories but weighing relatively very little, such as nuts, cookies, fried foods in general, and most snack foods (including fat-free brands), is considered energy dense. Foods with low energy density include fruits, vegetables, and any food that incorporates lots of water during cooking, such as oatmeal. 2.2 Dietary Guidelines for Americans have been issued to help improve the health of all Americans age 2 and older. The guidelines emphasize a healthy eating pattern that includes a variety of vegetables from all of the subgroups, whole fruits, whole grains, fat-free or low-fat dairy, a variety of protein foods, and oils; and limits saturated fats, added sugars, and sodium. 2.3 MyPlate and accompanying online tools are designed to translate nutrient recommendations into a food plan that exhibits variety, balance, and moderation. The best results are obtained by using low-fat or fat-free dairy products, incorporating some vegetable proteins in the dietary pattern in addition to animal-protein foods, including citrus fruits and dark-green vegetables, and emphasizing whole grain breads and cereals. 2.4 A person's nutritional state can be categorized as optimal when the body has adequate nutrient stores for times of increased needs. Malnutrition encompasses both states of undernutrition and overnutrition: undernutrition, which may be present with or without clinical symptoms; and overnutrition, which can lead to vitamin and mineral toxicities and various obesity-related chronic diseases. 2.5 Evaluation of nutritional state involves analyzing background factors, as well as anthropometric, biochemical, clinical, dietary, and environmental assessments. It is not always possible to detect nutritional inadequacies via nutritional assessment because symptoms of deficiencies are often nonspecific and may not appear for many years. 2.6 Recommended Dietary Allowances (RDAs) are set for many nutrients. These amounts yield enough of each nutrient to meet the needs of healthy individuals within specific gender and age categories. Adequate Intake (AI) is the standard used when not enough information is available to set a more specific RDA. Estimated Energy Requirements (EERs) set calorie needs for both genders at various ages and physical activity patterns. Tolerable Upper Intake Levels (Upper Levels or ULs) for nutrient intake have been set for some vitamins and minerals. Chronic Disease Risk Reduction Intakes (CDRR) intakes have been set for sodium and potassium and are the only DRIs specific to disease risk. All of these dietary standards fall under the term Dietary Reference Intakes (DRIs). Daily Values are used as a basis for expressing the nutrient content of foods on the Nutrition Facts label and are based for the most part on the RDAs. 2.7 Apply the basic principles of nutrition to evaluate any nutrition claim. Several indicators of nutrition misinformation include insufficient scientific evidence to support a product claim, lack of credible sources, promises of unbelievable results, or distrust of the medical community. To sort nutrition fact from fiction, seek the advice of a registered dietitian nutritionist. 2.8 Food labels, especially the Nutrition Facts labels, are a useful tool to track your nutrient intake and learn more about the nutritional characteristics of the foods you eat. Changes to the Nutrition Facts label have been approved and include increasing the type size for Calories, Servings per container, and Serving size. Any health claims listed must follow FDA-set criteria.
energy density
A comparison of the calorie (kcal) content of a food with the weight of the food. An energy-dense food is high in calories but weighs very little (e.g., potato chips), whereas a food low in energy density has few calories but weighs a lot (e.g., an orange) measurement that best describes the calorie content of a food. Energy density of a food is determined by comparing the calorie (kcal) content with the weight of food. A food that is rich in calories but weighs relatively little is considered energy dense. Examples include nuts, cookies, fried foods, and even some fat-free snacks such as fat-free pretzels. Foods with low energy density include fruits, vegetables, and any food that incorporates lots of water during cooking, such as oatmeal Eating a meal with many foods of low energy density promotes satiety without contributing many calories. people consume fewer calories in a meal if most of the food choices are low in energy density, compared with foods high in energy density. An eating pattern low in energy density can aid in losing (or maintaining) weight. Overall, foods with lots of water and fiber (i.e., low-energy-density foods) contribute few calories even though they help one feel full. Alternatively, foods with high energy density must be eaten in greater amounts to promote fullness. SOCIAL DETERMINANTS: consumption of unhealthy diets—in particular, eating fewer fruits and vegetables—is strongly linked to socioeconomic status. Unfortunately, low-energy-density foods, such as fresh fruits and vegetables, are often more expensive than those that have high energy density. Therefore, the cost of food has been identified as a likely contributor to the socioeconomic patterning in healthy diets
overnutrition
A state in which nutritional intake greatly exceeds the body's needs. Prolonged consumption of more nutrients than the body needs can lead to overnutrition. In the short run (e.g., 1 to 2 weeks), overnutrition may cause only a few symptoms, such as stomach distress from excess iron intake. If an excess intake continues, however, some nutrients may accumulate to toxic amounts, which can lead to serious disease. For example, too much vitamin A during pregnancy can cause birth defects. The most common form of overnutrition in developed nations is an excess intake of calories that leads to obesity. In the long run, outcomes of obesity include other serious diseases, such as type 2 diabetes and certain forms of cancer. T
added sugars and saturated fats
Added sugars and saturated fats are energy dense (high in calories) but provide few essential nutrients. Dietary patterns predominated by these food components especially increase risk for obesity, type 2 diabetes, hypertension, cardiovascular disease, and cancer. Added sugars include sugars and other sweeteners that are added during food processing or cooking. The recommendation is to limit intake of added sugars to less than 10% of total calories per day. Saturated fats are primarily animal fats, such as butter and beef fat. They can be found naturally in foods and are also added during food processing and cooking. Replacing saturated fats with unsaturated fats may reduce risk of cardiovascular disease. the recommendation is to limit intake of saturated fats to less than 10% of total calories per day. The limit of less than 2300 mg of sodium per day coincides with the Chronic Disease Risk Reduction Intakes for those 14 years and older. Although those who do not drink alcohol should not begin drinking to attain health benefits, moderate alcohol consumption is associated with reduced risk of cardiovascular disease, cognitive decline, and death.
types of physical activity and key recommnedations
Aerobic Includes forms of activity that are intense enough and performed long enough to maintain or improve an individual's cardiorespiratory fitness. anaerobic Refers to high-intensity activity that exceeds the capacity of the cardiovascular system to provide oxygen to muscle cells for the usual oxygen-consuming metabolic pathways. muscle-strengthening Activities that maintain or improve muscular strength, endurance, or power. bone-strengthening Movements that create impact and muscle-loading forces on bone. balance training Training activities and movements that safely challenge postural control. flexibility training Also called stretching, these activities improve the range and ease of movement around a joint mind-body Typically combine muscle strengthening, balance training, light-intensity aerobic activity, and flexibility in one package Preschool children (ages 3 through 5) Should be physically active throughout the day. Adult caregivers should encourage active play that includes a variety of activity types. Children and adolescents (ages 6 through 17)Engage in 60 minutes or more of moderate-to-vigorous physical activity daily that should include: -Aerobic: Most of the 60 minutes or more per day should be either moderate or vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity on at least 3 days each week. -Muscle-strengthening: Children and adolescents should include muscle-strengthening physical activity on at least 3 days each week. -Bone-strengthening: Children and adolescents should include bone-strengthening physical activity on at least 3 days each week. adults Adults who sit less and do any amount of moderate-to-vigorous physical activity gain health benefits. -For substantial health benefits, adults should do at least 150 to 300 minutes a week of moderate-intensity, or 75 to 150 minutes a week of vigorous-intensity, aerobic physical activity, or an equivalent combination of moderate and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week. -Additional health benefits are gained by engaging in physical activity beyond 300 minutes of moderate-intensity physical activity each week. -Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days each week. older adults As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Older adults should determine their level of effort for physical activity relative to their level of fitness. Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely. When older adults cannot do 150 minutes of moderate-intensity aerobic activity each week because of chronic conditions, they should be as physically active as their abilities and conditions allow. adults with chronic health conditions and disabilities: Adults with chronic conditions or disabilities, who are able, should do at least 150 to 300 minutes each week of moderate-intensity, or 75 to 150 minutes a week of vigorous-intensity, aerobic physical activity, or an equivalent combination of moderate and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week. Adults with chronic conditions or disabilities, who are able, should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days each week. When adults with chronic conditions or disabilities are not able to meet the preceding key guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity. Adults with chronic conditions or symptoms should be under the care of a health care provider. People with chronic conditions can consult a health care professional or physical activity specialist about the types and amounts of activity appropriate for their abilities and chronic conditions. guidelines for safe physical activity: To do physical activity safely and reduce risk of injuries and other adverse events, people should: Understand the risks, yet be confident that physical activity can be safe for almost everyone. Choose types of physical activity that are appropriate for their current fitness level and health goals, because some activities are safer than others. Increase physical activity gradually over time to meet key guidelines or health goals. Inactive people should "start low and go slow" by starting with lower intensity activities and gradually increasing how often and for how long activities are done. Protect themselves by using appropriate gear and sports equipment, choosing safe environments, following rules and policies, and making sensible choices about when, where, and how to be active. Be under the care of a health care provider if they have chronic conditions or symptoms. People with chronic conditions and symptoms can consult a health care professional or physical activity specialist about the types and amounts of activity appropriate for them.
ABCDEs of nutritional assessment for evaluating nutritional health:
Anthropometric Biochemical Clinical Dietary Environmental
evaluating nutrition info; how tomake healthful and logical nutrition decisions:
Apply the basic principles of nutrition along with the Dietary Guidelines for Americans and related resources to any nutrition claim, including those on websites. Do you note any inconsistencies? Do reliable references support the claims? Beware of the following: Testimonials about personal experience Nonreputable publication sources without peer review Promises of dramatic and often rapid results (rarely true) Lack of evidence from other scientific studies Examine the background and scientific credentials of the individual, organization, or publication making the nutritional claim. Usually, a reputable author is one whose educational background or present affiliation is with a nationally recognized university or medical center that offers programs or courses in the field of nutrition, medicine, or other health-related specialty. Be wary if the answer is Yes to any of the following questions about a health-related nutrition claim: Are only advantages discussed and possible disadvantages ignored? Are claims made about curing disease? Do they sound too good to be true? Is extreme bias against the medical community or traditional medical treatments evident? Health professionals as a group strive to cure diseases in their patients, using proven techniques that are available. They do not ignore reliable cures. Is the claim touted as a new or secret scientific breakthrough? Note the size and duration of any study cited in support of a nutrition claim. The larger it is and the longer it went on, the more dependable its findings. Also consider the type of study: epidemiology versus case-control versus double-blind study. Check out the group studied; a study of men or women in Sweden may be less relevant than one of men or women of Southern European, African, or Hispanic descent, for example. Keep in mind that contributes to, is linked to, or is associated with does not mean causes. Beware of news conferences and other hype regarding the latest findings. Much of this will not survive more detailed scientific evaluation. When you meet with a nutrition professional, you should expect that he or she will do the following: Ask questions about your medical history, lifestyle, and current eating habits. Formulate a dietary pattern tailored to your specific needs. Schedule follow-up visits to track your progress, answer any questions, and help keep you motivated. Page 64 Involve family members in the eating plan, when appropriate. Consult directly with your primary care provider and readily refer you back to your primary care provider for those health problems a nutrition professional is not trained to treat. Avoid practitioners who prescribe megadoses of vitamin and mineral supplements for everyone. Examine product labels carefully. Be skeptical of any promotional information about a product that is not clearly stated on the label. the best approach to finding answers about your nutritional state is to consult your primary care provider or registered dietitian nutritionist first. Overall, nutrition is a rapidly advancing field, and there are always new findings. In addition, the USDA Fraud and Nutrition Misinformation website can help you evaluate ongoing nutrition and health claims (www.nal.usda.gov/fnic/fraud-and-nutrition-misinformation for more information).
Chronic Disease Risk Reduction Intake (CDRR)
Category of DRIs based upon chronic disease risk DRIs are reference values that provide recommendations for adequate and safe intakes in apparently healthy individuals. Yet we established new Chronic Disease Risk Reduction Intakes (CDRR) DRI category. These are the first DRIs that are disease-specific and target risk reduction for chronic disease. The CDRR value for sodium was set after it was found to be linked to the risk of cardiovascular disease.
food philosophy that works
Consume a variety of foods balanced by a moderate intake of each food. Health professionals have recommended the same basic eating and lifestyle patterns for many years: Control the quantity of food you eat. Pay attention to what you eat: choose more whole grains, fruits, and vegetables. Stay physically active: move more and sit less. basics of a healthful eating pattern: variety, moderation, and balance.
daily value
Daily Value is a generic standard used on the food label. The percentage of the Daily Value (% Daily Value or % DV) is usually given for each nutrient per serving. These percentages are based on a 2000 kcal diet and must be adjusted for people who require considerably more or less than 2000 kcal per day with respect to fat and carbohydrate intake. DVs are mostly set at or close to the highest RDA value or related nutrient standard seen in the various age and sex categories for a specific nutrient. DVs allow consumers to compare their intake from a specific food to desirable (or maximum) daily intakes.
Estimated Energy Requirement (EER)
Estimate of the energy (kcal) intake needed to match the energy use of an average person in a specific life stage For calorie needs, we use the Estimated Energy Requirement (EER) instead of an RDA or AI. In contrast to the RDAs, which are set somewhat higher than the average needs for nutrients, the EER is set for the average person. the calculation of EER needs to be more specific, taking into account age, biologic sex, height, weight, and physical activity (e.g., sedentary or moderately active). In some cases, the additional calorie needs for growth and lactation are also included EER is based on the "average" person. Thus, it can only serve as a starting point for estimating calorie needs
Dietary Guidelines:
Following are the five foundational guidelines of the Dietary Guidelines: 1)Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. 2) Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts. 3) Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns. 4) Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain. 5) Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.
food quality and food quantity
Food quality is just as important as food quantity when it comes to good nutrition.
exceptions to food labeling
Foods such as fresh fruits, vegetables, and fish currently are not required to have Nutrition Facts labels. The % Daily Value for protein is not mandatory on foods because protein deficiency is not a public health concern in the United States. If the % Daily Value for protein is given on a label, FDA requires that the product be analyzed for protein quality. labels on food for infants and children under 4 years of age must include the % Daily Value for protein, as must the labels on any food carrying a claim about protein content.
functional foods
Foods that have health benefits beyond basic nutrition. Foods rich in phytochemicals are now part of a family of foods referred to as functional foods. A functional food provides health benefits beyond those supplied by the traditional nutrients it contains. For example, a tomato (highlighted in the "Farm to Fork" feature in Chapter 1) contains the phytochemical lycopene, so it can be called a functional food.
micronutrient, subclinical deficiency
Hidden hunger describes a state of micronutrient deficiency, when the quality of food one consumes does not meet their nutrient requirements for normal metabolic functions and maintenance. Once availability of a nutrient falls sufficiently low, biochemical evidence indicates that the body's metabolic processes have slowed or stopped. At this state of deficiency, there are no outward symptoms; thus, it is termed a subclinical deficiency. A subclinical deficiency can go on for some time before individuals suffer detectable symptoms. . Clinical evidence of a nutritional deficiency—perhaps in the skin, hair, nails, tongue, or eyes—can occur within months, but overt symptoms may take years to develop. Often, clinicians do not detect a problem until a deficiency produces outward symptoms, such as excessive bruising from a vitamin C deficiency.
variety
MEANS EATING MANY DIFFERENT FOODS Variety in your dietary pattern means choosing foods from all the food groups and subgroups, rather than eating the "same old thing" day after day. Variety makes meals more interesting and helps ensure that they contain sufficient nutrients. A variety of foods is best because no one food meets all your nutrient needs. different foods and food groups vary in the nutrients they contain. For now, just recognize that you need a variety of foods in your eating pattern because the required nutrients are scattered among many foods. As you incorporate a wide variety of foods in your eating pattern, be mindful of your total calorie intake.
balance
MEANS EATING MORE NUTRIENT-DENSE FOODS Balance, also referred to as proportionality, is eating more nutrient-dense foods and beverages such as fruits, vegetables, whole grains, and fat-free or low-fat milk products, as well as fewer foods high in certain types of fat, sugars, cholesterol, salt, and alcohol. Balance also refers to matching your energy intake (how many total calories you consume) with energy expenditure (calories burned by metabolism and physical activity) over time. A prolonged imbalance between energy intake and energy expenditure leads to fluctuations in body weight.
nutrient-dense and energy-dense foods advice
Many foods, such as peanut butter, are both energy and nutrient dense. Even energy-dense foods can have a place in your dietary pattern, but you will have to plan for them. For example, chocolate is a very energy-dense food, but a small portion at the end of a meal can supply a satisfying finale. In addition, foods with high energy density can help individuals with poor appetites, such as some older people, to maintain or gain weight.
Tolerable Upper Intake Level (UL)
Maximum chronic daily intake level of a nutrient that is unlikely to cause adverse health effects in almost all people in a specific life stage. set for some vitamins and minerals (Appendix G). The UL is the highest amount of a nutrient unlikely to cause adverse health effects in the long run. As intake exceeds the UL, the risk of ill effects increases
biochemical assessment:
Measurement of biochemical functions (e.g., concentrations of nutrient by-products or biologic activities in the blood, feces, or urine) related to a nutrient's function , an in-depth examination of nutritional health is impossible without the more expensive process of biochemical assessment. This involves the measurement of the concentrations of nutrients and nutrient by-products in the blood, urine, and feces and the activities of specific blood enzymes.
anthropometric assessment:
Measurement of body weight and the lengths and proportions of parts of the body. Anthropometric assessment is used to assess the size, shape, and composition of the human body. These measurements often include body mass index (height, weight), circumference measures, bioelectrical impedance, and skinfold measures.
Adequate Intakes (AIs)
Nutrient intake amount set for any nutrient for which insufficient research is available to establish an RDA. AIs are based on estimates of intakes that appear to maintain a defined nutritional state in a specific life stage there is not enough information on some nutrients, such as chromium, to set such a precise standard as an RDA. For these nutrients, the DRIs include a category called an Adequate Intake (AI). This standard is based on the dietary intakes of people who appear to be maintaining nutritional health. That amount of intake is assumed to be adequate, as no evidence of a nutritional deficiency is apparent.
Recommended Dietary Allowance (RDA)
Nutrient intake amount sufficient to meet the needs of 97% to 98% of the individuals in a specific life stage RDAs and related standards are intended mainly for diet planning. Specifically, an eating pattern should aim to meet the RDA or AI as appropriate and not to exceed the UL over the long term A Recommended Dietary Allowance (RDA) is the daily amount of a nutrient that will meet the needs of nearly all individuals (about 98%) in a particular age and gender group. significant deviation below (about 70%) or above (about three times or more for some nutrients) the RDA for an extended time can eventually result in a deficiency or toxicity of that nutrient, respectively.
qualified health claims examples:
Qualified claims about cancer risk: Tomatoes and/or tomato sauce and prostate, ovarian, gastric, and pancreatic cancers Calcium and colon/rectal cancer and calcium and recurrent colon/rectal polyps Qualified claims about cardiovascular disease risk: Nuts and heart disease Omega-3 fatty acids and coronary heart disease Monounsaturated fatty acids from olive oil and coronary heart disease
Daily Value (DV)
Quantity (expressed in percentage) of a specific nutrient that corresponds to the total percentage of the daily requirements for a particular nutrient based on a 2000 kcal diet. nutrition standard more relevant to everyday life is the Daily Value (DV). This is a generic standard used on food labels. It is applicable to both genders from 4 years of age through adulthood and is based on consuming a 2000 kcal diet. DVs are mostly set at or close to the highest RDA value or related nutrient standard seen in the various age and gender categories for a specific nutrient and are listed in Appendix A. DVs have been set for vitamins, minerals, total fat and carbohydrate, and other dietary components. For fat and cholesterol, the DVs represent a maximum level, not a goal one should strive to reach. DVs allow consumers to compare their intake from a specific food to desirable (or maximum) intakes.
nutrient standards/recommendations included under the DRI umbrella:
RDAs AIs EERs Upper Levels or ULs CDRRs
moderation
REFERS MAINLY TO PORTION SIZE Eating in moderation requires paying attention to portion sizes and planning your daily eating pattern. is imp for all food components YOU CAN GET TOO MUCH OF A GOOD THING! large doses of vit E like from supplements can lead to excessive bleeding bcuz of its effects on blood clotting choose foods that help you limit intake of saturated fat, added sugars, salt, and alcohol. Americans typically consume too much of these food components—and too many calories overall. EXAMPLE: For example, if you plan to eat a bacon cheeseburger (relatively high in fat, salt, and calories) at lunch, you should eat foods such as fruits and vegetables, including salad greens (less concentrated sources of these nutrients), at other meals that same day. If you prefer whole milk to low-fat or fat-free milk, reduce the fat elsewhere in your meals. Try low-fat salad dressings or use jam rather than butter or margarine on toast. Overall, it is more feasible to consume moderate portions of foods that supply lots of saturated fat, salt, and sugar than to try to eliminate these foods altogether.
serving sizes and food claims on food label
Serving sizes on the Nutrition Facts label must be consistent among similar foods. This means that all brands of ice cream, for example, must use the same serving size on their label. food claims made on packages must follow legal definitions. A long list of definitions for nutrient claims allowed on food labels is given in Table 2-11. For example, if a product claims to be "low sodium," it must have 140 milligrams of sodium or less per serving
def for common nutrient claims allowed on food labels
Sugar Sugar free: less than 0.5 gram (g) per serving No added sugars; without added sugars: No sugar or sugar-containing ingredient is added during processing. Reduced sugar: at least 25% less sugar per serving than reference food Calories Calorie free: fewer than 5 kcal per serving Low calorie: 40 kcal or less per serving and, if the serving is 30 grams or less or 2 tablespoons or less, per 50 grams of the food Reduced or fewer calories: at least 25% fewer kcal per serving than reference food Fiber High fiber: 5 grams or more per serving (Foods making high-fiber claims must meet the definition for low fat, or the level of total fat must appear next to the high-fiber claim.)Good source of fiber: 2.5 to 4.9 grams per serving More or added fiber: at least 2.5 grams more per serving than reference food Fat Fat free: less than 0.5 gram of fat per serving Low fat: 3 grams or less per serving and, if the serving is 30 grams or less or 2 tablespoons or less, per 50 grams of the food; 2% milk can no longer be labeled low fat, as it exceeds 3 grams per serving; reduced fat will be the term used instead. Reduced or less fat: at least 25% less per serving than reference food Sodium Sodium free: less than 5 milligrams per serving Low sodium: 140 milligrams or less per serving or, if the serving is 30 grams or less or 2 tablespoons or less, per 50 grams of the food Reduced or less sodium: at least 25% less per serving than reference food Other Terms Fortified or enriched: Vitamins and/or minerals have been added to the product in amounts in excess of at least 10% of that normally present in the usual product. Enriched generally refers to replacing nutrients lost in processing, whereas fortified refers to adding nutrients not originally present in the specific food. Healthy: An individual food that is low fat and low saturated fat and has no more than 360 to 480 milligrams of sodium or 60 milligrams of cholesterol per serving can be labeled "healthy" if it provides at least 10% of the Daily Value for vitamin A, vitamin C, protein, calcium, iron, or fiber. Light or lite: The descriptor light or lite can mean two things: first, that a nutritionally altered product contains one-third fewer kcal or half the fat of reference food (if the food derives 50% or more of its calories from fat, the reduction must be 50% of the fat), and second, that the sodium content of a low-calorie, low-fat food has been reduced by 50%. The term light may still be used to describe such properties as texture and color, as long as the label explains the intent; for example, "light brown sugar" and "light and fluffy." Diet: A food may be labeled with terms such as diet, dietetic, artificially sweetened, or sweetened with nonnutritive sweetener only if the claim is not false or misleading. The food can also be labeled low calorie or reduced calorie. Good source: Good source means that a serving of the food contains 10% to 19% of the Daily Value for a particular nutrient. If 5% or less, it is a low source. High: High means that a serving of the food contains 20% or more of the Daily Value for a particular nutrient. Organic: Federal standards for organic foods allow claims when much of the ingredients does not use chemical fertilizers or pesticides, genetic engineering, sewage sludge, antibiotics, or irradiation in production. At least 95% of ingredients (by weight) must meet these guidelines to be labeled "organic" on the front of the package. Source: U.S. Department of Agriculture If the front label instead says "made with organic ingredients," only 70% of the ingredients must be organic. For animal products, the animals must graze outdoors, must be fed organic feed, and cannot be exposed to large amounts of antibiotics or growth hormones. Natural: The food must be free of food colors, synthetic flavors, or any other synthetic substance. The following terms apply only to meat and poultry products regulated by USDA. Extra lean: less than 5 grams of fat, 2 grams of saturated fat, and 95 milligrams of cholesterol per serving (or 100 grams of an individual food) Lean: less than 10 grams of fat, 4.5 grams of saturated fat, and 95 milligrams of cholesterol per serving (or 100 grams of an individual food)
dietary reference intakes (DRIs)
Term used to encompass nutrient recommendations made by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine. These include RDAs, AIs, EERs, CDRRs, CDRRs, and ULs.
mediterranean diet pyramid
The Mediterranean Diet Pyramid (Fig. 2-9) is a useful alternative to MyPlate. It is based on the dietary patterns of the southern Mediterranean region, which has enjoyed low recorded rates of chronic diseases and high adult life expectancy. An abundance of research supports the health benefits of following the Mediterranean Diet.1,2 The Dietary Guidelines include the Healthy Mediterranean-Style Eating Pattern, which contains more fruits and seafood and less dairy than the Healthy U.S.-Style Eating Pattern. based on dietary patterns from the Mediterranean region, which has low rates of chronic diseases and high life expectancy. Base every meal on fruits, vegetables, whole grains, olive oil, beans, nuts, legumes, and seeds; eat fish and seafood at least two times per week; eat poultry and eggs every two days or weekly; eat cheese and yogurt daily to weekly; eat meats and sweets less often; drink water; drink red wine in moderation; be physically active and enjoy meals with others.
nutritional state:
The nutritional health of a person as determined by anthropometric measurements (height, weight, circumferences, and so on), biochemical measurements of nutrients or their by-products in blood and urine, a clinical (physical) examination, a dietary analysis, and economic evaluation; also called nutritional status an optimal nutritional state. Adequate nutritional status is needed to ensure body tissues have enough of each nutrient to support normal metabolic functions and surplus stores that can be used in times of increased nutritional need. An optimal nutritional status can be achieved by obtaining essential nutrients from a variety of foods and adhering to the Dietary Guidelines.
nutrient density
The ratio derived by dividing a food's nutrient content by its calorie content. When the food's overall nutrient contribution exceeds its contribution to calorie need, the food is considered to have a favorable nutrient density. The nutrient density of a food is a characteristic used to determine its nutritional quality. Nutrient density of a food is determined by comparing its protein, vitamin, or mineral content with the amount of calories it provides. A food is deemed nutrient dense if it provides a large amount of nutrients for a relatively small amount of calories when compared with other food sources. Foods with greater nutrient density are better sources of nutrients. Generally, nutrient density is determined with respect to individual nutrients. The nutrient-dense options are foods that have important nutrients but are not packed with extra calories, saturated fat, added sugars, or sodium. Many low-cost, nutrient-dense foods—such as fat-free and low-fat milk, lean meats, legumes (beans), oranges, carrots, broccoli, whole wheat bread, and whole grain breakfast cereals—do help balance less nutrient-dense foods such as cookies and potato chips, which many people like to eat.
transgender issue seems to be more common currently, especially in teens and young adults. Should nutrition requirements for transgender individuals be based on birth-assigned sex or identified/expressed gender?
The term transgender refers to someone's expression of gender. Gender expression (or gender identity) is unrelated to the physical attributes of a person (i.e., sex). For transgender individuals, the sex they were assigned at birth and their own gender identity do not match. On the other hand, cisgender individuals share the same gender as their birth-assigned sex. Because most people identify as cisgender, we use this term less often. Sexual orientation, or the gender to which one is attracted, is not related to gender identity. In the medical field, understanding an individual's gender identity is sometimes complicated because an individual's birth-assigned sex is often listed as gender on medical documentation regardless of the person's gender identity. In fact, many medical institutions and insurance companies do not accept transgender identity as an option on medical charts. Simply asking about and acknowledging a person's gender expression and preferred pronoun are important first steps to improving the overall health care experience for transgender individuals. almost 30% of participants reported postponing medical care due to perceived discrimination from their health care providers, while 19% reported being refused medical care completely. . Should we rely on the nutrient recommendations for the transgender individual's birth-assigned sex or the individual's gender identity? Calorie, protein, and fluid requirements are typically no different between transgender and cisgender individuals. Nutrition professionals who work with transgender clients have started relying on gender-neutral estimates for calorie, protein, and fluid needs, which are based on body weight. Slight differences between male and female recommendations can be easily adjusted by a registered dietitian nutritionist. Nutritional requirements certainly do change as a result of physical (i.e., surgical) or hormonal interventions. To promote healing after transition surgery, protein and calorie needs will increase. Transgender individuals may also elect to utilize hormonal therapy as part of the transition process (with or without surgical interventions). Although the timing of these effects may vary, hormone therapy may alter a person's metabolic rate. current recommendations for some micronutrients also vary by sex. At this time, there are no specific DRIs for transgender individuals. order to ensure consistent and supportive care, close collaboration and honest communication between transgender individuals and the health care team are essential. As more research data are gathered, we will have greater insight into the specific nutrient requirements for this community.
dietary assessment
Then, a close look at the person's eating pattern (dietary assessment), including a record of previous dietary intake or food frequency would help to determine any possible problem areas. Estimation of typical food choices relying mostly on the recounting of one's usual intake or a record of one's previous days' intake.
food label
This food and beverage labeling is monitored by government agencies such as the Food and Drug Administration (FDA) in the United States. The listing of certain food constituents is also required—specifically, on a Nutrition Facts label (Fig. 2-13). Consumers can use the information in the Nutrition Facts label to learn more about what they eat. The following components must be listed: Total calories (kcal) Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrate Fiber Total sugars Added sugars Protein Vitamin D Calcium Iron Potassium optional: manufacturers can choose to list polyunsaturated and monounsaturated fat, additional vitamins and minerals, and others. Listing an additional nutrient becomes required if the food is fortified with that nutrient or if a claim is made about the health benefits of the specific nutrient.
nutrient claims allowed at this time include:
claims allowed at this time may show a link (a "may" or "might" qualifier must be used in the statement) between an eating pattern and the following: enough calcium and vitamin D and a reduced risk of osteoporosis. low in total fat and a reduced risk of some cancers. low in saturated fat and cholesterol and a reduced risk of heart disease. rich in fiber—containing grain products, fruits, and vegetables—and a reduced risk of some cancers. low in sodium and a reduced risk of hypertension and stroke. rich in fruits and vegetables and a reduced risk of some cancers. adequate in the synthetic form of the vitamin folate (folic acid) and a reduced risk of neural tube defects. sugarless gum and a reduced risk of tooth decay. rich in fruits, vegetables, and grain products that contain fiber and a reduced risk of cardiovascular disease. a diet rich in whole grain foods and other plant foods, as well as low in total fat, saturated fat, and cholesterol, and a reduced risk of cardiovascular disease and certain cancers. low in saturated fat and cholesterol that also includes 25 grams of soy protein and a reduced risk of cardiovascular disease. The statement "one serving of the (name of food) provides _____ grams of soy protein" must also appear as part of the health claim. fatty acids from oils present in fish and a reduced risk of cardiovascular disease. margarines containing plant stanols and sterols and a reduced risk of cardiovascular disease. EX: Cheerios® are made from oats, which can be singled out in reducing the risk of cardiovascular disease as long as the statement also says that the eating pattern should be low in saturated fat and cholesterol.
health claims on food labels
claims on foods fall into one of four categories: Health claims—closely regulated by FDA Preliminary health claims—regulated by FDA, but evidence may be scant for the claim Nutrient claims—closely regulated by FDA (review Table 2-11) Structure/function claims—these are not FDA approved, or necessarily valid Currently, FDA limits the use of health messages to specific instances in which there is significant scientific agreement that a relationship exists between a nutrient, food, or food constituent and the disease.
Limitations of Nutritional Assessment
delayed symptoms and signs symptoms due to different causes -Many signs and symptoms are not very specific- could be nutritional or unrelated (diarrhea, skin or fatigue) -Signs and symptoms can take a long time to develop and can seem vague -A long time between development and clinical evidence (i.e. high cholesterol building to artery issues) , clinical symptoms of some nutritional deficiencies (e.g., diarrhea, inability to walk normally, and facial sores) are not very specific. These may have causes other than poor nutrition. The long time it takes for symptoms to develop and their potential to be vague often make it difficult to establish a link between an individual's current dietary pattern and nutritional state.
background factors for evaluating nutritional health
family health history plays an important role in determining nutritional and health status, it must be carefully recorded and critically analyzed as part of a nutritional assessment. includes (1) a medical history, especially for any disease states or treatments that could decrease nutrient absorption or ultimate use; (2) a list of medications taken; (3) a social history (e.g., marital status and living conditions); (4) a health literacy level; and (5) an economic status to determine the ability to access and prepare food.
empty-calorie foods
foods that offer few, if any, nutrients but do supply calories less nutrient-dense foods such as cookies and potato chips, which many people like to eat. The latter are often called empty-calorie foods because they tend to be high in sugar and/or saturated fat but provide few other nutrients.
labeling of food allergens
he Food Allergen Labeling and Consumer Protection Act (FALCPA) requires manufacturers to label food products that contain an ingredient that is or contains protein from a major food allergen. first option is to include the name of the food source in parentheses following the common or usual name of the major food allergen in the list of ingredients if the name of the food source of the major allergen does not appear elsewhere in the ingredient list. The second option is to put the word Contains followed by the name of the food source from which the major food allergen is derived immediately after or adjacent to the list of ingredients in type size that is no smaller that the ingredient type size (e.g., Contains Wheat, Milk, Eggs, and Soy).
caloric balance within healthy eating patterns
he balance between calories consumed (from foods and beverages) and calories expended (through physical activity and metabolic processes) determines body weight. Consuming too many calories without increasing physical activity will inevitably lead to weight gain, which exacts an enormous toll on individuals and communities. Knowing how many calories you need each day is a good place to start (Fig. 2-5). Use an online calculator such as NutritionCalc Plus in Connect to calculate your estimated calorie needs. Next, become familiar with the calorie content of foods and beverages. Finally, monitoring weight over time will allow you to see how your food and physical activity choices are balancing out.