module 10:adults
Discuss the 3500-kcal rule and how it relates to weight change.
1 lb of fat ≈ 3500 kcal 3500 kcal/7 days in a week = 500 kcal/d To lose weight, create a deficit (eat less, exercise more, or both) of 500 kcal/d below estimated energy requirements (EER) To gain weight, create a surplus (eat more, exercise less if exercise has been excessive, or both) of 500 kcal/d above EER NOTE: The 3500 kcal rule is nice and neat and easy to use, but research shows that it overestimates weight changes. In real life, other factors besides food intake and exercise influence weight change and it takes longer than 1 week to fully realize the effect of an energy deficit or surplus.
Compare actual beverage intake to recommended beverage intake.
Across age groups, ~21% of kcal in American diets come from beverages, and most of these are not nutrient-dense choices. The figure below shows average volume of various types of beverages typically consumed by Americans.
Discuss the physiological effects of gut dysbiosis.
Changes in body weight Inflammation Insulin resistance Dyslipidemia
Describe typical changes in body composition that occur during adulthood.
Decreased bone mineral density may lead to osteopenia and eventually, to osteoporosis.Gradual loss of bone mass begins after age 30 among men and women.A phase of rapid bone loss occurs around age 50 among women due to menopause (decreased estrogen). Positive energy balance typically leads to increased adiposity, which is related to increased risk for many chronic diseases. Lack of physical activity and hormonal changes typically lead to decreased lean mass. Sarcopenic obesity: decreases in lean mass accompanied by increases in fat mass.
Recognize the effects of metabolic syndrome.
Diabetes: increases risk by 5X Heart disease: increases risk by 2X to 4X Stroke: increases risk by 2X Fatty liver Obstructive sleep apnea Polycystic ovary syndrome Cognitive decline/dementia Inflammation Thrombosis
Popular weight-loss plans approach weight management from various angles: restricting carbohydrates, restricting fat, intermittent fasting, etc. The most important element for a successful weight-loss program is moderate calorie deficit (~500 kcal/d below EER).The deficit can be achieved by reducing food intake, increasing physical activity, or bothEnsure that protein and micronutrient needs are met.The moderate calorie deficit must be sustained over the long term.
Discuss the pros and cons of popular diets.
Outline the Eating Competence Model.
Eating attitudes: positive relationship with food and eating Food acceptance: enjoyment of a variety of foods, including nutritious foods Regulation of food intake: attention to internal hunger and satiety cues Eating context: planning meals and snacks
Name some public assistance programs that help adults with limited resources to obtain food.
Extension programs Supplemental Nutrition Assistance Program (SNAP) Food banks Soup kitchens Congregate or home-delivered meals
(Loosely) define the segments of adulthood.
In everyday language, adulthood is divided into the following segments Early adulthood: 20 to 40 years Midlife: 40 to 60 years Later/older adulthood: 60+ years DRIs make distinctions for nutrient requirements using the following age ranges 19 to 30 years 31 to 50 years 51 to 70 years >70 years
Suggest dietary and lifestyle strategies to manage metabolic syndrome.
Lose excess weightCalorie controlExercise Focus on fat quality (replace saturated fat with unsaturated fat) Focus on carbohydrate quality (replace refined carbohydrates with whole grains, fruits, and vegetables) Effective dietary guidesMediterranean dietMyPlateDASH Diet
Label the sections of MyPlate.
MyPlate is the visual representation of the Dietary Guidelines for Americans. MyPlate depicts proportionality.
Recall the functions of magnesium.
Nerve impulse transmission, muscle contraction, regulation of heart rate Energy production Bone health DNA, RNA, and protein synthesis
Differentiate between osteopenia and osteoporosis.
Osteopenia: low bone mineral density Osteoporosis: significantly low bone mineral density that leads to fractures
Define social determinants of health.
Socioeconomic and environmental factors (mostly uncontrollable) that influence nutritional status and overall health of a population
what is intuitive eating
involves honoring your body's sensations of hunger and satiety and avoiding restrictive diets. Reject the diet mentality Honor your hunger Make peace with food Challenge the food police Discover the satisfaction factor Feel your fullness Cope with your emotions with kindness Respect your body Movement - feel the difference Honor your health - gentle nutrition
Compare typical fiber intakes of American adults to the AI for fiber.
AI for fiber: 14 g/1000 kcal~25 g/d for adult women~38 g/d for adult men Americans typically achieve ~1/2 the AI, which is not optimal for bowel function and may put them at risk for obesity, diabetes, and cardiovascular disease.
Recall the Acceptable Macronutrient Distribution Ranges (AMDRs) for adults.
AMDRs summarize what current research shows is compatible with nutrient adequacy and low risk of chronic disease. Carbohydrates: 45% to 65% of total kcal Fat: 20% - 35% of total kcal Protein: 10% to 35% of total kcal
Use the American Cancer Society's Guidelines on Nutrition and Physical Activity for Cancer Prevention in diet planning.
Achieve and maintain a healthy body weight throughout life Be physically active Eat a healthy diet with an emphasis on plant foods If you drink alcohol, limit your intake
Describe the importance of a healthy gut microbiota.
Activates and supports the immune system Releases some nutrients from food Synthesizes some vitamins (vitamin K and biotin synthesized by bacteria can be absorbed and can contribute to human nutritional status) Produces postbiotics: metabolic products of microorganisms that influence human health (e.g., blood lipids, neurotransmitter synthesis).
Recognize that adipose tissue is metabolically active.
Adipocytes (i.e., fat cells) secrete hormones and hormone-like factors that influence health. Inflammation Insulin resistance
Outline the Key Physical Activity Guidelines for Adults.
Adults should move more and sit less throughout the day. Some physical activity is better than none. Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits. For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 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 the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a 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 a week, as these activities provide additional health benefits.
Outline the Key Guidelines for Adults with Chronic Health Conditions and Adults with Disabilities.
Adults with chronic conditions or disabilities, who are able, should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 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 a week, as these activities provide additional health benefits. When adults with chronic conditions or disabilities are not able to meet the above 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.
Recall that energy needs typically decline throughout adulthood.
After age 30, basal metabolic rate gradually declines with age (declines ~2% per decade for women; ~2.9 per decade for men) Reduced physical activity
Recognize the influence of genetics on risks for certain chronic diseases.
American Indians and Alaskan Natives have higher risk for type 2 diabetes than other groups ( Asian populations develop chronic diseases at lower BMI and waist circumferences than other population groups african-Americans are more likely than whites to develop hypertension. Hypertension develops earlier in life and is more severe among African-Americans. Thus, African-Americans have high rates of heart disease and stroke
Recall the functions of vitamin E.
Antioxidant - prevents oxidation of lipids (e.g., cell membranes, lipoproteins) Immune function
Describe the relationship between blood lipids and atherosclerosis.
Atherosclerosis: accumulation of plaque along the lining of blood vessels, leading to stiffening and narrowing of the blood vesselsHeart attackStrokePeripheral vascular disease Plaque contains lipids (particularly oxidized LDL), collagen, muscle, white blood cells, and calcium Dyslipidemia is a risk factor for atherosclerosisElevated LDLElevated triglyceridesLow HDL
Use body mass index (BMI) to assess weight status of adults
BMI = kg/m2 BMI is a convenient screening tool, but it does not truly assess body composition Consider hydration status Consider muscle mass
Describe how to assess weight status of adults.
BMI is a quick, non-invasive screening tool, but it does not truly assess body composition Waist circumference provides additional information about body fat distributionThere are some variations in methods, but waist circumference is typically measured just above the hip bone (i.e., iliac crest) or at the level of the umbilicus.Be sure to memorize the thresholds used as indicators for chronic disease for adults (based on data for North Americans)>40 inches (>102 cm) for men>35 inches (>88 cm) for womenBe aware that these cutoffs may vary based on ethnicity Weight change from young adulthood can be an indicator of increased risk for and earlier onset of chronic diseases
Recognize that many people with diabetes are using complementary and alternative medicine in addition to or in place of medical therapies.
Bitter melon Cinnamon Fenugreek Ginseng Gymnema Chromium Biotin
Describe the roles of calcium and vitamin D in bone health.
Calcium: component of hydroxyapatite (bone mineral) Vitamin D: regulates calcium homeostasis (along with parathyroid hormone)Absorption (small intestine)Bone remodeling (osteoclasts)Excretion (kidneys)
Discuss the effects of climacteric change on risks for chronic diseases.
Climacteric change: decline in reproductive function that occurs with age in both men and women Menopause: decline in reproductive hormones in women, usually defined as the absence of menstrual periods for 12 months; average age of menopause is 51 yearsIncrease in abdominal fatIncreased risk for cardiovascular disease Rapid bone loss Decreased lean mass Decline in testosterone production among men Decreased lean mass
Use the American Heart Association's Diet and Lifestyle Recommendations in diet planning.
Eat a variety of fresh, frozen, and canned vegetables and fruits without high-calorie sauces or added salt and sugars. Replace high-calorie foods with fruits and vegetables. Choose poultry and fish without skin and prepare them in healthy ways without added saturated and trans fat. If you choose to eat meat, look for the leanest cuts available and prepare them in healthy and delicious ways. Choose fiber-rich whole grains for most grain servings. Eat a variety of fish at least twice a week, especially fish containing omega-3 fatty acids (for example, salmon, trout and herring). Select fat-free (skim) and low-fat (1%) dairy products. Avoid foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet. Limit saturated fat and trans fat and replace them with the better fats, monounsaturated and polyunsaturated. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that's about 13 grams of saturated fat. Cut back on beverages and foods with added sugars. Choose foods with less sodium and prepare foods with little or no salt. To lower blood pressure, aim to eat no more than 2,300 milligrams of sodium per day. Reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further. If you can't meet these goals right now, even reducing sodium intake by 1,000 mg per day can benefit blood pressure. If you drink alcohol, drink in moderation. That means no more than one drink per day if you're a woman and no more than two drinks per day if you're a man. Follow the American Heart Association recommendations when you eat out, and keep an eye on your portion sizes.
Define energy density
Energy density: general comparison of kcal content to serving size Foods with high fluid and fiber contents have low energy density Choosing foods with low energy density can help with weight management
Describe the components of energy intake and energy expenditure.
Energy intake (from foods and beverages) Carbohydrate Fat Protein Alcohol Energy expenditure Basal metabolism: energy expended for cellular metabolic processes (e.g., pumping ions across cell membranes) and function of organs (e.g., heartbeat, breathing, brain function, etc.); accounts for 60% to 75% of total energy expenditure Activity thermogenesis: energy expended through physical activity (e.g., activities of daily living and planned exercise) and nonexercise activity (e.g., fidgeting, shivering); accounts for 20% to 40% of total energy expenditure. Thermic effect of food: energy needed to digest, absorb, and metabolize nutrients; accounts for 5% to 10% of total energy expenditure
Outline the 2020 - 2025 Dietary Guidelines for Americans.
Follow a healthy dietary pattern at every life stage. For the first time in this edition, the Dietary Guidelines provide specific recommendations for infants and toddlers. Customize and enjoy nutrient-dense food and beverages choices to reflect personal preferences, cultural traditions, and budgetary considerations. In the last edition, there was a novel emphasis on the importance of overall dietary patterns rather than individual foods or nutrients. A dietary pattern refers to the combination of foods and beverages that constitutes an individual's complete dietary intake over time. The dietary patterns message is still a big part of the new Dietary Guidelines, but this edition also highlights the need to personalize the general advice to the individual. Over the past few years, social determinants of health have really come to light as big influences on dietary patterns. This term is not specifically defined in your book. Social determinants of health (Links to an external site.)are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These include factors such as housing, access to a safe food supply, access to health care, and level of education. focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits. The key recommendations for food groups have not changed since the last edition. A healthy dietary pattern includes:Vegetables of all types (dark green vegetables; red and orange vegetables; beans, peas, and lentils; starchy vegetables; other vegetables)Fruits (focus on whole fruits rather than fruit juices)Grains (including whole grains along with refined grains . . . we will learn why both are beneficial)Dairy (focus on low-fat or fat-free dairy products; plant-based milk alternatives are also in this category, but consider the importance of fortification to match the nutrient profile of cow's milk)Protein foods (choose leaner cuts of meat, poultry, and eggs; include some seafood; incorporate more plant-based proteins)Oils (emphasize plant oils, nuts, seeds, and seafood) Limit foods and beverages higher in added sugars, saturated fat, sodium, and limit alcoholic beverages. The advice for adults has not changed, but there are some new recommendations for infants and children. <10% of total kcal from added sugars (new advice for children under age 2: avoid foods and beverages with added sugars) <10% of total kcal from saturated fat (starting at age 2) <2300 mg of sodium per day (lower CDRRs are set for children under age 14) <2 drinks per day for men; <1 drink per day for women
Outline the physiological effects of atherosclerosis.
Hypertension Ischemia: reduced blood flow to organs and limbs Fatigue Shortness of breath Angina: chest pain Heart attack Stroke Peripheral artery disease
Understand the relationship between hypertension and atherosclerosis.
Hypertension can contribute to atherosclerosis because high blood pressure can damage arteries and atherosclerosis is initiated when a blood vessel is damaged. Atherosclerosis also worsens hypertension because, as arteries become blocked and less flexible, the force of blood moving through the vessel increases. In November 2017, the American College of Cardiology and American Heart Association released new guidelines for the classification of hypertension. A blood pressure reading of <120/<80 is still normal, but the threshold for hypertension is now lower. The overall effect of the new guidelines is that more Americans are now categorized as having hypertension and medical treatment should begin sooner.
List common methods of determining energy needs of adults.
Indirect calorimetry Measurement of respiratory quotient (compares oxygen consumed to carbon dioxide produced as macronutrients are metabolized) Preferred method in clinical setting, but equipment may not be available Predictive equations: hundreds of equations are available to estimate energy requirements based on height, weight, age, gender, and physical activity (you do not need to memorize these equations for this class)Mifflin-St. Jeor equation Harris-Benedict equation Food and Nutrition Board (EER) equation Simple estimate (memorize these!) ~13 kcal/lb/d to gradually lose weight ~15 kcal/lb/d to maintain current body weight ~17 kcal/lb/d to gradually gain weight
Explain why the health of the sandwich generation is at risk.
Many middle-aged adults are simultaneously taking care of their children and their aging parents (i.e., they are sandwiched between two generations who depend upon them). Family responsibilities combined with work responsibilities may severely limit the time middle-aged adults have to take care of themselves (e.g., prepare healthy meals, exercise regularly).
Use the key dietary principles of the 2020 - 2025 Dietary Guidelines for Americans in diet planning.
Meet nutritional needs primarily from foods and beverages.The dietary patterns presented in the DGAs meet the RDAs and AIs for essential nutrients and fall within the AMDRs for carbohydrates, fats, and proteins.If meeting nutrient needs from foods is not possible, informed use of fortified foods and/or dietary supplements can fill nutrient gaps. Choose a variety of options from each food group. Helps to meet nutrient needs; no food supplies all essential nutrients.Allows for flexibility in diet planning.Fresh, canned, dried, frozen, and 100% juices, in nutrient-dense forms, can be included in healthy dietary patterns. Pay attention to portion size.
Recall fluid needs of healthy adults.
Men need to drink 13 cups of fluid per day (the AI for total water, including water from foods as well as beverages, is 15 cups per day) Women need to drink 9 cups of fluid per day (the AI for total water, including water from foods as well as beverages, is 11 cups per day) For most adults, drinking fluids in response to thirst will support adequate hydration.
Suggest dietary modifications to treat cardiovascular disease.
Moderate total fat intakeAmerican Heart Association (AHA) recommends 20% to 35% of total kcal from fatNational Cholesterol Education Program (NCEP) recommends 25% to 35% total kcal from fat Limit saturated fat intakeAHA recommends an upper limit of 5% to 6% of total kcal from saturated fatNCEP recommends an upper limit of 7% of total kcal from saturated fat Limit dietary cholesterol intakeAHA no longer includes a specific recommendation for dietary cholesterolNCEP recommends <200 mg/d cholesterol Limit added sugar intakeDietary Guidelines recommend an upper limit of 10% of total kcal from added sugarsAHA recommends an upper limit of 100 kcal (6 tsp) from added sugars for women or 150 kcal (9 tsp) from added sugars for men 2 g/d of plant stanols or sterols: reduce cholesterol absorption 10 to 25 g/d of soluble (viscous) fiber: reduces cholesterol absorption At least 30 min/d moderate-intensity physical activity on most, and preferably all, days of the week.
Compare typical potassium intakes of American adults to the AI.
Most Americans fall short of the AI for potassium, which may place them at risk for hypertension. In March 2019, the National Academy of Medicine released updated dietary reference intakes for potassium. The AI for healthy adults has been lowered from 4700 mg/d for all adults to 3400 mg/d for adult men and 2600 mg/d for adult women. In the future, revised recommendations for people with (or at risk for) hypertension may be set. There is not enough evidence to set an Upper Level (UL) for potassium.
Compare typical vitamin E intakes of American adults to the RDA.
Most Americans fall short of the RDA for vitamin E, which may put them at risk for immune dysfunction, cancer, and cardiovascular disease.
Compare the typical magnesium intakes of American adults to the RDA.
Most Americans fall slightly short of the RDA for magnesium, which may put them at risk for a variety of chronic diseases, including cardiovascular disease, diabetes, and cance
Compare typical vitamin A intakes of American adults to the RDA.
Most adults fall slightly short of vitamin A recommendations, which may put them at risk for immune dysfunction, cancer, and cardiovascular disease. Most Americans would benefit from consuming more plant sources (provitamin A carotenoids) rather than animal sources (retinoids).
Compare the typical iron intakes of American adults to the RDA.
Most men achieve the RDA of 8 mg/d Most women fall short of the RDA of 18 mg/d, placing them at risk for anemia and poor pregnancy outcomes
Suggest dietary and lifestyle strategies to manage diabetes.
NOTE: Diet plans should be tailored to the individual, but these are general guidelines. Calorie control to achieve or maintain healthy body weight Establish a regular meal pattern that distributes carbohydrates throughout the dayMatch carbohydrate intake with medication/insulin regimenConsider carbohydrate qualityPeople with diabetes do not need to avoid simple sugars or fruits, they simply need to account for them within the meal plan Focus on fat quality Regular physical activity/reduce sedentary time Self-monitoring of blood glucose Effective toolsExchange lists (Food Lists for Diabetes (Links to an external site.)) are still used by many practitioners, but in general, the trend is moving toward carbohydrate countingGlycemic index/glycemic load are advanced concepts that may be useful for patients with lots of experience with diet planning, but in general, emphasizing whole grains and unprocessed fruits and vegetables has the same effect Carbohydrate counting
Define nutrient density.
Nutrient density: general comparison of nutrient content to kcal content Choosing foods with high nutrient density helps to ensure nutrient adequacy Food may be nutrient dense and energy dense at the same time
Compare typical calcium intakes of American adults to the RDA.
RDA for calcium: 1000 mg Men tend to meet the RDA; women tend to achieve slightly less than the RDA, which may put them at risk for osteoporosis.
Compare typical vitamin D intakes of American adults to the RDA.
RDA for vitamin D for adults: 15 mcg (600 IU) Most American adults fall VERY short of the RDA for vitamin D, which may put them at risk for osteoporosis, immune dysfunction, and cancer. Estimates vary based on the threshold used to define vitamin D deficiency. Using a threshold of <50 nmol/L, recent research shows that ~40% of the adult population has vitamin D deficiency
Outline characteristics of comprehensive weight-loss plan.
Realistic goalsUp to 2 lb/week is a reasonable weight-loss goal Calorie deficitRecall the "3500-kcal rule" (described below)Deficit may come from reduced intake, increased physical activity, or both Meal planTailored to the individual's medical needs, preferences, lifestyle, and budgetFits into the framework of family meals Skill developmentFood selectionLabel-readingFood preparation Problem-solving techniquesVacations and holidaysOvercoming a plateau Self-monitoring and self-management Cognitive restructuringCorrect all-or-none thinkingEmpower, build confidence Stress management Support system Regular exerciseSome exercise is better than none!Gradual implementation is okayMen >40 y and women >50 y or anyone who has been sedentary should seek medical evaluation before embarking on a new exercise programExercise is EXTREMELY important for weight maintenanceBeyond weight loss, exercise helps to control blood lipids, blood pressure, and blood glucose Plan for maintenance Long-term effectivenessBehaviors can be sustainedLong-term follow-up enhances success
Recall the functions of iron.
Red blood cell health, oxygen transport Reproductive function Cognitive health Immune function
Recall the functions of potassium.
Regulation of fluid balance: higher intakes of potassium are associated with lower blood pressure Nerve impulse transmission Muscle contraction
Recall the functions of sodium.
Regulation of fluid balance: higher intakes of sodium are associated with higher blood pressure Nerve impulse transmission Muscle contraction Cotransport of substances across cell membranes (e.g., absorption of glucose and amino acids from the small intestine, excretion of acidic compounds from the kidneys)
Describe the physiological effects of uncontrolled blood sugar.
Short termPolydipsia: increased thirstPolyuria: increased urinationPolyphagia: increased hungerWeight lossFatigueBlurred visionInfectionsDelayed wound healing Long termMicrovascular damageRetinopathy: eye damageNephropathy: kidney damageNeuropathy: nerve damageMacrovascular damageAtherosclerosis - heart disease is the leading cause of death among people with diabetes
Summarize the principles of the non-diet approach.
Some health professionals promote a weight-neutral, non-diet approach, which shifts the focus away from body weight and body size, and instead emphasizes other important indicators of health (e.g., blood lipids, blood glucose control, functional abilities, and mental health). There are several ways to implement a non-diet approach. Please note that none of these should be viewed as a weight-loss strategy! Sometimes, learning to pay closer attention and respond to internal signals of hunger and satiety can result in weight loss, but sometimes it does not. The non-diet approach is less about weight loss and more about multidimensional wellness.
Describe the rationale behind the Beverage Guidance System.
The Beverage Guidance System was developed by obesity researchers based on science that shows the impact of beverages choices on health outcomes. In the diets of Americans, ~21% of kcal come from beverages. Calories consumed in the form of beverages have less satiety value than calories consumed in the form of food. Except for milk and juice, calorically-sweetened beverages have low nutritional value. Although caffeine does act as a diuretic, caffeine-containing beverages still do contribute to total daily fluid intake.
Compare the typical sodium intakes of American adults to the CDRR.
The CDRR for sodium for adults is 2300 mg/d. Most Americans (about 80%) exceed the CDRR, which may place them at risk for hypertension and some types of cancer NOTE: In March 2019, the National Academy of Medicine released updated dietary reference intakes for sodium. The AI for adults remains at 1500 mg/d. There have been changes to the AI for other age groups. Most notably, the DRI committee determined there is not enough evidence to support a lower AI for older adults, nor enough evidence to set an Upper Level (UL) for sodium. There is, however, a new recommendation set for people who have or are at risk for hypertension: the Chronic Disease Risk Reduction (CDRR) Intake. This essentially takes the place of the UL we knew before - it's 2300 mg/d. If sodium intake is higher than 2300 mg/d, adults at risk for chronic diseases should lower their sodium intake.
Recognize that 5 of the 10 leading causes of death in the United States are closely related to nutrition and weight status.
The most recent data show that heart disease is currently the leading cause of death in the United States. (It's a close race between heart disease and cancer!) Of the 10 leading causes of death, heart disease, cancer, stroke, diabetes, and kidney disease are very closely related to nutrition. Nutritional factors may also play a role in development of Alzheimer's disease.
Discuss causes of obesity.
Traditionally, obesity researchers have focused on the "big two"Excess energy intakeInadequate physical activity There are many other factors beside the "big two" that may influence development of obesity. (Just for fun, check out this giant paper that summarizes ten theories about the causes of obesity: McAllister et al, 2009 (Links to an external site.))Genetic traits: due to alterations in DNAEpigenetic factors: changes in gene expression that are not due to changes in DNA, may be influenced by early nutritional and other environmental exposuresNeuroendocrine influences:Metabolic obesity: in accordance with the set point theory (see below), changes in hormones (e.g., thyroid hormone, leptin) may subvert behavior changes aimed at weight lossHedonic obesity: some individuals are hyperresponsive to the reward value of food (i.e., overeating despite feeling full)Socioeconomic factorsCultural factorsStress, anxiety, depressionSleep patternsMeal timingInfluence of gut microbiota Many researchers describe a "set point," which is a body weight that is maintained over time by neurological and endocrine mechanisms despite small fluctuations in energy intake and physical activity.Changes in hormones that regulate appetiteChanges in hormones that regulate metabolic rate Obesogenic environment: environmental factors that promote overeating (e.g., food advertising, availability of energy-dense foods) and inactivity (e.g., unsafe space for exercise, lack of sidewalks, elevators, remote controls)
Recognize that, for weight loss, overall calorie deficit is more important than the macronutrient composition of the diet.
Traditionally, research shows greatest success with weight loss and long-term maintenance with low-fat diets Low-carbohydrate diets can be useful and are not detrimental to health as long as the dieter can maintain the plan over time and chooses plant sources of protein more often than animal sources
Differentiate between type 1 and type 2 diabetes mellitus.
Type 1 diabetes: hyperglycemia due to lack of insulin productionUsually develops during childhood5% to 10% of cases Medical treatment always involves insulin Type 2 diabetes: hyperglycemia due to insulin resistanceStrongly associated with obesityUsually develops during adulthood, but prevalence is increasing among youth90% to 95% of casesMedical treatment involves oral medications; insulin may be required in advanced cases
Define obesity.
Unhealthy accumulation of body fat Based on BMI, obesity is defined as ≥ 30 kg/m2. Based on body composition, obesity is defined as body fat ≥ 25% for men or ≥ 35% for women.
Recall that approximately half of adults use dietary supplements.
Use of dietary supplements increases with age. Some herbal supplements have pharmacologic effects; may interact with prescription medications. Patients may underreport supplement use.
Describe medical interventions for weight loss.
Very-low-calorie diets (VLCDs; some texts refer to them as very-low-energy diets): liquid meal replacements provide 400 to 800 kcal/d Meet protein, essential fatty acid, and micronutrient needs Low in carbohydrates and fat These can serve as a jump start for a person who has a lot of weight to lose, but they are NOT a long-term solution Weight regain is common Weight-loss medications: may improve weight loss when combined with lifestyle strategies Some reduce fat digestion (e.g., orlistat) Some influence appetite (e.g., phentermine, lorcaserin) NOTE: FDA recently requested that the makers of the weight-loss drug Belviq (lorcaserin) voluntarily remove it from the market due to safety concerns. This course does not go in depth about pharmacology, but I think it's important to stay abreast of changes in the market, which is always changing! Here's more information about the safety notice Bariatric surgery: Some reduce stomach volume to restrict the amount of food the person can eat at one time (e.g., gastric band, sleeve gastrectomy) Some also induce malabsorption of nutrients (e.g., Roux-en-Y gastric bypass)
Recall the functions of vitamin A.
Vision Immune functionProduction of white blood cells Integrity of skin and mucosal cells Antioxidant (beta-carotene)
Recognize that vitamin D is important for MUCH more than just bone health.
Vitamin D regulates phosphorus absorption, too. Vitamin D is involved in regulation of gene transcription, so it affects many areas of health: Immune response - risk for autoimmune diseases, in particular Cellular differentiation - cancer riskInsulin secretion - diabetes risk Renin production - risk for hypertension Muscle function
Recommend healthy beverage choices for adults.
Water should be the beverage of choice. Unsweetened coffee or tea are acceptable for hydration, but too much caffeine (more than 800 mg/d) can cause rapid heart rate, insomnia, anxiety, and may aggravate heartburn or ulcers. Low-fat or fat-free milk is a nutrient-dense beverage choice, but be mindful of its kcal contribution. 100% fruit juice can be a nutrient-dense beverage choice, but it is better to choose whole fruit because it has lower energy density and provides fiber and other phytochemicals. Avoid sugar-sweetened beverages; limit artificially sweetened beverages. Drink alcohol in moderation, if at all.Up to 1 drink per day for womenUp to 2 drinks per day for men
The Health at Every Size (HAES) movement endorses 5 main principles
Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.
Discuss the health benefits of fiber.
Weight management Bowel function Blood glucose control Cardiovascular health
Relate dietary behaviors to risks for chronic diseases.
Which dietary patterns may increase risk for obesity (i.e., obesogenic diet)? Excess calorie intakeExcess fat (probably because of its contribution to excess calories)Excess added sugars (extra calories and possibly due to hyperinsulinemia, which could promote fat storage) Unstructured eating (i.e., not planning for several nutrient-dense meals and snacks throughout the day) Frequent fast food consumption Which dietary and lifestyle patterns may increase risk for cancers (i.e., carcinogenic diet)?Inadequate intake of antioxidant nutrients (e.g., beta-carotene, vitamin C, vitamin E, selenium, and zinc)Low intake of fruits and vegetablesLow intake of whole grains (versus refined grains)Excessive calorie intake is particularly linked with increased risk for cancers of the digestive and female reproductive organs High intake of dietary fat (the association is probably due to the contribution of excess fat intake to excess energy intake) Excessive intake of alcohol is particularly linked with increased risk for cancers of the GI tract, liver, and breast Excessive intake of sodium (e.g., fast food, processed foods, pickled foods) is particularly linked with increased risk for cancers of the stomach High intake of carcinogenic compoundsNitrates/nitrites from processed meatsHeterocyclic amines and polycyclic aromatic hydrocarbons from grilled/charred meats Which dietary patterns may increase risk for cardiovascular disease (i.e., atherogenic diet)? Excessive calorie intake, which contributes to excess body fat and increased oxidative stress High intake of saturated fat, which contributes to atherosclerosis High intake of trans fat (although these are not very common in the food supply since the ban on trans fats went into effect in 2018), which contributes to atherosclerosis Low intake of plant-based foods (e.g., fruits, vegetables, whole grains, legumes, nuts, and seeds), which are good sources of antioxidant nutrients, which would protect cells from oxidative damage Excessive alcohol intake OR no alcohol intake; moderate alcohol intake helps to prevent blood clots and also increases HDL High sodium intake, especially coupled with low potassium intake, due to their effects on blood pressure Low intake of milk and dairy foods. Calcium is important for nerve function and muscle contraction, so meeting the RDA is good for heart function. Adequate calcium intake from foods has also been associated with lower risk for hypertension. However, some studies indicate that use of calcium supplements may promote atherosclerosis. (This may be because calcium is part of the plaque that builds up in blood vessels.) Whatever the mechanism, it's advised to get your calcium from foods rather than supplements. What dietary factors may increase risk for type 2 diabetes (i.e., diabetogenic diet)? See obesogenic diet See atherogenic diet
what is mindful eating
is based on the Zen practice of mindfulness. Mindful eating involves Being aware of physical hunger and satiety cues Respecting inner wisdom about food choices Gratitude for the source of the food Feeling the sensory experience of eating Acknowledging personal responses to food
Recall the prevalence of obesity among American adults.
~42% of adults have BMI ≥ 30 kg/m2 (CDC, 2020 (Links to an external site.)) Although the trend of rising prevalence of overall overweight and obesity has leveled off in recent years, the prevalence of severe obesity (BMI ≥40 kg/m2) is rapidly increasing.
