Ch 13: Nutrition for Health and Disease in Adults

risk factors for cardiovascular disease: obesity

- Intra-abdominal fat affects blood pressure and blood lipid levels - Can affect body's ability to use insulin - Directly contributes to heart disease

risk factors for metabolic syndrome

Abdominal obesity High levels of triglycerides Low levels of HDL cholesterol High blood pressure High fasting plasma glucose

definition of overweight/obesity

Abnormal or excessive fat accumulation in the body World Health Organization (WHO) definitions: - Overweight: BMI ≥ 25 - Obese: BMI ≥ 30

prevention of cancer

Abstain from tobacco use and avoid exposure to secondhand smoke Modify lifestyle to minimize controllable risks with diet and physical activity

prevention of diverticular disease

Adequate fiber, fluids, exercise

abdominal fat

Also called visceral fat Can lead to increased levels of lipids, which increases risk of cardiovascular disease

cardiovascular disease

Any disease or injury of heart and its blood vessels as well as blood vessels throughout the body and in the brain Prevents in many forms - Coronary heart disease (CHD) - Cerebrovascular disease - Peripheral artery disease - Aortic atherosclerosis - Thoracic or abdominal aortic aneurysm

medication management for obesity

Approved for patients with a BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 when complicated by obesity comorbidity Drugs used to treat obesity in the United States: - Phentermine - Diethylpropion - Phendimetrazine - Benzphetamine - Orlistat

risk factors for obesity: race & ethnicity

Asians: 12.7% (males: 10.1%; females: 14.8%) Non-Hispanic whites: 37.9% (males: 37.9%; females: 38.0%) Non-Hispanic blacks: 46.8% (males: 36.9%; females: 54.8%) Hispanics: 47.0% (males: 43.1%; females: 50.6%)

prevention of cardiovascular disease: body weight

BMI used to determine whether weight is in healthy range Waist measurement and waist-to-hip ratio also used to assess a person's excess body fat Physical activity: - Helps maintain and decrease weight - Lowers cholesterol and blood pressure Maintain a healthy weight through healthy eating and exercise per the physical activity guidelines

surgical treatment of obesity

Bariatric surgery considered for BMI of ≥ 40 or BMI of ≥ 35 who have cardiopulmonary disease or type 2 diabetes Focuses on reducing amount of food stomach an hold Has shown improvement in type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea Requires comprehensive assessment by a multidisciplinary team prior to surgery and presurgical instruction on: - Healthy eating and physical activity patterns - Behavioral strategies to implement lifestyle changes - Importance of stress reduction and social support Increases risk of developing nutrient deficiencies

risk factors for obesity: physical activity

CDC states 7 of the 10 most common chronic diseases favorably influenced by regular physical activity. U.S. Department of Health and Human Services activity guidelines for adults with chronic conditions or disabilities: - 150 to 300 minutes of moderate-intensity per week or 75 to 150 minutes of vigorous-intensity aerobic activity - Muscle-strengthening activities involving all major muscle groups 2 or more days a week - If unable to meet above guideline, engage in regular physical activity according to their abilities. - Should be under the care of a healthcare provider

obesity epidemic

Can classify over 2 billion people in the world as overweight or obese

nutritional treatment of cancer

Cancer and treatment can lead to anorexia, early satiety, changes in taste and smell, and bowel issues Can lead to inadequate nutrient intake and eventually cause malnutrition Goals during treatment: - Prevent or resolve nutrient deficiencies - Achieve or maintain healthy weight - Preserve lean body mass - Minimize nutrition-related side effects - Maximize quality of life Use of dietary supplements controversial Oral nutrition supplements/nutrition support may be used.

prevention of IBD

Cause unknown, difficult to prevent Focus on controllable risk factors of stress, diet, smoking, physical activity, and sufficient sleep

prevention of IBS

Cause unknown, therefore difficult to prevent Focus on controllable risk factors of stress, diet, and avoidance of irritating foods

Prevalence and etiology of cancer

Caused by mutation in DNA that causes cells to alter normal functions and exhibit rapid, uncontrolled growth Postulated: proto-oncogenes activated by carcinogens - Physical, chemical, or biological agents Gene mutations may be caused by variety of factors - Smoking, radiation, viruses, cancer-causing chemicals, obesity, hormones, chronic inflammation, and lack of exercise Common types of cancer: - Breast, lung and bronchus, prostate, colon and rectum, bladder, melanoma of the skin, non-Hodgkin lymphoma, thyroid, kidney and renal pelvis, endometrial, leukemia, liver, and pancreatic

risk factors for cardiovascular disease: smoking

Causes approximately 20% of cardiovascular disease Can result in disturbances to endothelium Decreases amount of oxygen blood carries Increases chance for clotting

irritable bowel syndrome (IBS) and prevalence

Chronic condition in which symptoms come and go - Discomfort and pain in abdominal area - Change in bowel patterns with changes in colon rhythm Prevalence and etiology of IBS - Affects 10-20% of U.S. adults - Affects approximately twice as many women - Most common in people < 45 years old - Gut motility transit times vary, possibly due to: -- Hereditary genetics -- Psychosocial factors -- Post inflammatory changes after GI infection

inflammatory bowel disease (IBD)

Chronic condition with periodic immune responses combined with inflammation in GI tract

how RDN's can create behavior modification plan for obesity

Cognitive restructuring Contingency management Relapse prevention techniques Social support and stress management Stimulus control and cue reduction

metabolic syndrome and prevalence

Combination of risk factors that include high cholesterol level, high blood sugar level, high blood pressure, and excess abdominal fat Predisposes an individual to higher risks of heart attack, stroke, and type 2 diabetes mellitus Prevalence and etiology of metabolic syndrome - Incidence is rising; increases with age - Occurs in nearly 35% of all U.S. adults - Highest among Hispanic and non-Hispanic black adults

cancer

Complex group of diseases with a variety of causes that cause uncontrolled, abnormal cell growth Cells can invade tissues Dietary, lifestyle, and health-related behavioral strategies important for both prevention and treatment

most common forms of IBD and their symptoms

Crohn's disease - Affects entire GI tract and all three mucosal layers Ulcerative colitis - Restricted to large intestine, and mucosa is affected Both involve similar symptoms: - Diarrhea - Abdominal discomfort - Symptoms involving skin, joints, and eyes

risk factors for cardiovascular disease: Diabetes and high blood pressure

Diabetes increases risk, even if blood glucose levels under control Hypertension most important risk factor for stroke

management of IBS

Diet therapy - Individualized based on symptom management - Food diaries helpful - Trial diet using FODMAP diet Adequate fluid intake Probiotics

traditional treatment in obesity

Dietary counseling, exercise, behavior modification Medications and bariatric surgery if not successful

hypertension and prevalence

Elevated blood pressure Risk factor for CAD, stroke, and kidney failure Prevalence and etiology of hypertension - 46% of adults in the U.S. have hypertension - May be primary or secondary

hypertension risk factors

Family history and ethnicity, advanced age, lack of physical activity, poor diet, overweight and obesity, alcohol consumption, stress, smoking, chronic kidney disease, adrenal and thyroid disorders, and sleep apnea

prevention of metabolic syndrome

Focus on preventing or decreasing abdominal obesity - Lifestyle modification recommended Prevent insulin resistance and hyperglycemia - Lifestyle modification and weight loss recommended Lower blood pressure to achieve goal of < 140/90 mm Hg - Lifestyle modification and follow DASH diet Healthy People 2030 focuses on strategies and interventions to assist people in eating more healthy foods Follow Physical Activity Guidelines for Americans, 2nd Edition

recommendations for long term disease-free individuals

Food safety - Increased risk of food borne infection with immunosuppressant cancer treatment Potentially protective foods - Active plant compounds (phytochemicals) in some fruits and vegetables may help prevent cancer Cruciferous vegetables - Intake may decrease risk of breast, prostate, stomach, and ovarian cancer Soy foods - May decrease risk of ovary, bladder, colon, liver, pancreas, lung, head, and neck cancer Catechins and flavonols may also be beneficial.

risk factors for obesity: family history and genes

Genes may increase susceptibility to obesity. - Abundance of food, inactivity, or both also needed for individual's weight to increase. Obesity risk is 2-8 times higher for a person with a family history of obesity. 2014 study found that consumption of fried foods could interact with genes related to obesity.

risk factors for type 2 diabetes

Genetic and environmental risk factors include age, obesity, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, ethnicity Modifiable risk factors: - Elevated blood glucose - Overweight and obesity - Hypertension - Abnormal lipids - Smoking - Physical activity

cerebrovascular disease

Group of conditions that affect circulation to brain, limiting or stopping blood flow (stroke, transient ischemic attack) Sudden onset May be stable, progressive, or completely resolved Most common cause is atherosclerotic disease

risk factors for cardiovascular disease: Age, gender, and genetics

Heart attacks earlier in life more common in men Older, postmenopausal women more likely to die if they have a heart attack Children whose parents had heart disease face greater risk. High rate of heart disease in men in African Americans, Native Americans, Alaskan Natives, Hispanics/Latinos, and Caucasians Heart disease high in women Pacific Islanders, Asian Americans, Native Americans, Alaskan Natives, and Hispanics/Latinas

prevalence and etiology of cardiovascular disease

Heart disease leading cause of death in U.S. 15.5 million people ≥ 20 years old have CHD - Includes myocardial infarction, angina pectoris, heart failure, and coronary death

physical activity management for obesity

Helps prevent weight regain when previously overweight Benefits: - Induces negative energy balance - Spares fat-free mass during weight loss - Improves cardiovascular fitness Must be combined with lower calorie diet to be most effective

type 2 diabetes mellitus and prevalence

Inadequate insulin and insulin resistance Prevalence and etiology of type 2 diabetes - Most prevalent form of diabetes - Occurs in an estimated 30.3 million people in the U.S. - Associated with insulin resistance an defects in insulin secretion - Often undiagnosed for many years because hyperglycemia develops gradually

management of cardiovascular disease: lower lipoprotein and triglyceride levels

Include 5-10 g of soluble viscous fiber per day Meet goal of total daily fiber intake Consume soy protein in place of animal protein 2 g/day of plant stanols and plant sterols Consume flavonoids (fruits and vegetables, wine, and tea) Consume fish that live in cold waters and are high in n-3 fatty acids Reduced sugar and alcohol consumption Consume probiotics

risk factors for cardiovascular disease: Blood cholesterol

Increasing levels increases risk of coronary heart disease Total cholesterol and high-density lipoprotein (HDL) cholesterol used to predict risk for heart attack or stroke - Low HDL cholesterol increases risk for heart disease. High low-density lipoprotein (LDL) cholesterol is a risk factor for atherosclerotic cardiovascular disease. High triglyceride level, combined with low HDL cholesterol or high LDL cholesterol, is associated with atherosclerosis

management of obesity

Individualized care Addressing genetic predisposition early in life Addressing environmental/societal factors First goal: prevent further weight gain Basic treatment plan should include: - Weight maintenance - Small, gradual weight loss (5-10%) over a 6-month period - Management of comorbidities

risk factors for cardiovascular disease: diet

Insulin resistance can lead to hyperglycemia and dyslipidemia, which contributes to atherosclerotic plaque formation. Poor diet can impact low-grade chronic inflammation linked to cardiovascular health. Protein, carbohydrates, and fat also linked to CVD

lifestyle factor risks for developing cancer

Level of exposure to carcinogens on a daily basis Dietary factors Alcohol consumption Overweight and obesity Physical inactivity General environment - UV radiation - Exposure to carcinogens in general and working environments

WHO recommendations for overweight/obesity: individual level

Limit energy intake from total fats and sugars Increase consumption of fruit and vegetables, legumes, whole grains, and nuts Engage in regular physical activity

management of metabolic syndrome

Long-term goals focus on prevention of type 2 diabetes, cardiovascular events, and other MetS-related outcomes Work with individuals to reduce risk of heart disease - Manage blood pressure - Lower LDL cholesterol and increase HDL cholesterol - Lower elevated triglycerides Physical activity - Encourage participation in regular physical activity - Assists in weight loss - Improves blood lipid levels - Decreases blood pressure - Helps with insulin resistance Nutrition therapy - No single diet plan recognized for management of metabolic syndrome - Incorporate lifestyle changes to initiate metabolic changes - Individualize meal plans to decrease energy intake - Mediterranean diet may reduce risk of metabolic syndrome. Weight management - Losing 5-7% of body weight can help reduce insulin levels.

management of cancer

Main approaches: - Surgery, radiation therapy, and chemotherapy General goal: - Prevent further cancer growth or remove potentially cancerous tissue Treatment physically demanding Must consider effect of cancer itself Often impacts physical activity and nutrition

risk factors for diverticular disease

May include low-fiber diet, aging, genetics, body weight, and other GI disorders

management of IBD

Medications used to suppress immune response and induce remission Diet therapy - Nutrition assessment imperative - Malnutrition present in up to 85% of patients with IBD - Weight loss occurs in both CD and UC - Food and symptom diary used - Nutrition intervention depends on status of GI tract Calorie and protein intake - Adequate to support repletion of weight/prevent weight loss if needed - Goal is to replenish nutrient stores - RDN must provide customized counseling - Increased protein needs with inflammation/infection Vitamins and minerals - Main deficiencies: Vitamins A and D, vitamin B12, folic acid, and iron

prevalence and etiology of overweight/obesity

More than tripled worldwide since 1976 Affected over 1.9 billion adults in 2016 Increasing in the U.S. - States adjacent to Mississippi River Basin >35% - Midwest and Southeast states 30-35% - Colorado, Hawaii, and District of Columbia 20-25% Large cost to the U.S. healthcare system Cause of reduced work productivity

dietary treatment of obesity

Multidisciplinary and interprofessional team approach Dietary approach should: - Involve a reduction in energy intake required - Be individualized and consider patient's preferences - Focus on food-based changes, portion control changes, and energy, macronutrient, and dietary pattern-based changes - Include larger behavioral changes, including adjusting energy intake, macronutrient consumption, dietary pattern, and dietary timing Majority of weight loss diets self-managed

Management of GERD

Must know what and when to eat to prevent flare-ups Goals of treatment: - Reduce reflux, relieve symptoms, and prevent damage to esophagus Diet and lifestyle modification recommended - Surgical therapy indicated when lifestyle and medical management fails and symptoms persist

peripheral artery disease

Narrowing of peripheral arteries to legs, stomach, arms, and head Increases risk of heart attack or stroke Usually caused by atherosclerosis in peripheral arteries

risk factors for IBD

No known direct cause Likely interaction between genes, immune system, and environmental factors Most commonly diagnosed between ages 15 and 40 years - Second wave between 50 and 80 years Slightly more women diagnosed Smoking may alleviate symptoms of ulcerative colitis "North American" diet may increase risk of Crohn's disease May also be linked to: -Refined sugar intake - Imbalance in gut microbiome - Stress and sleep deprivation

risk factors for cardiovascular disease

Non-modifiable risk factors: - Family history, ethnicity, and age Modifiable risk factors: - Tobacco exposure, high blood pressure, low-density lipoprotein cholesterol levels, obesity, physical inactivity, diabetes mellitus, unhealthy diet, and harmful use of alcohol

risk factors for cancer

Older age, personal or family history of cancer, using tobacco, obesity, chronic inflammation, alcohol use, some types of viral infections, exposure to specific chemicals, and exposure to radiation, including ultraviolet radiation from the sun Lifestyle factors: - Poor eating patterns, physical inactivity, smoking, and obesity Can also occur as a result of an abnormal gene passed from generation to generation

maintenance of healthy weight

One of the most important factors in prevention or treatment of virtually every chronic disease

obese body shape

Pear shape common in women Apple shape common in men

risk factors for obesity: age

People with BMI over 30: 20-39 years old: 35.7% 40-59 years old: 42.8% 60 years and older: 41.0% - Most excess weight gain between 25 and 34 years old Continues slowly throughout the rest of the life cycle Exception: menopause is a time of quick weight gain

risk factors for obesity: environment

Physical, social, political, and economic surroundings impact eating and physical activity - Healthy foods more expensive - Busy schedules - Long commutes - Limited food availability - Access to convenience foods - Lack of park and recreation areas

risk factors for GERD

Pregnancy Alcohol intake Poor posture Consuming large meals Eating just before bedtime Diabetes

Prevalence and etiology of diverticular disease

Prevalence increases with age Starts with herniation of colonic mucosa and muscularis mucosa through intestinal wall Diverticulitis occurs with inflammation of diverticula Complications may include intestinal obstruction, bleeding, abscess, fistula, and perforation Majority of people have no symptoms

prevalence and etiology of IBD

Prevalence increasing Occurs in about 3 million Americans Causes variety of symptoms that change over time: - Diarrhea - Rectal bleeding - Bowel urgency - Abdominal cramps and pain - Sensations of incomplete evacuation - Constipation that can lead to bowel obstruction

activity monitoring for obesity

Provide quantitative and qualitative information on an individual's activity behavior Devices now include fitness trackers, smart watches, heart rate monitors, and GPS tracking devices. Combination of activity monitors and in-person counseling found most beneficial for weight loss

WHO recommendations for overweight/obesity: food industry

Reduce fat, sugar, and salt content of processed foods Ensure healthy and nutritious choices are available and affordable Restrict marketing of foods high in sugars, salt, and fats Ensure availability of healthy food choices and support regular physical activity practices in the workplace

prevention of GERD

Reduce risk factors. - Lose weight if BMI is above average. - Avoid fatty foods. - Consume low-fat dairy foods

diet management of type 2 diabetes

Refer diabetic patients for medical nutrition therapy (MNT), which focuses on: - Promoting healthy eating - Encouraging consumption of nutrient-dense foods - Managing portion size - Maintaining healthy body weight - Improving blood glucose and lipid levels For individuals with gastroparesis symptoms: - Small-particle-size foods - Fat and fiber content decreased - Clear fluids often provided

management of type 2 diabetes

Requires many management strategies - Self-management - Diabetes education - Clinical support Goal: - Maintain blood glucose levels within a range that prevents or reduces risk of complications Treated and managed through: - Regular physical activity - Healthy dietary intake - Loss of excess weight - Medications

risk factors for cardiovascular disease: Physical inactivity

Risk factor for coronary heart disease Physical activity can reduce risk

behavior modification for obesity

Self-monitoring food intake and activity level Controlling stimuli Slowing eating Setting goals Building social support

prevention of cardiovascular disease: diet

Should include nutrient-dense foods, plenty of fresh fruits and nonstarchy vegetables, whole grains, legumes, moderate amount of nuts, seafood, lean meats, low-fat dairy, and vegetable oil Substitute complex carbohydrates for simple carbohydrates. Replace saturated fats with monounsaturated and polyunsaturated fats. Reduce or eliminate consumption of trans fats. Limit sodium, cholesterol, and added sugars

Factors in weight gain

Slowing of metabolism Decrease in vigor of physical activity

gastroesophageal reflux disease (GERD) and prevalence

Stomach contents reflux into the esophagus Graded as mild, moderate, or severe Symptoms: heartburn, regurgitation, and esophagitis Prevalence and etiology of GERD - Prevalence increasing - Occurs in 18-28% of North American adults - Characterized by symptoms occurring more than twice weekly

risk factors for IBS

Stress Intestinal motility disorders Diet Menstrual cycle Low-fiber diets Consumption of suspected irritating foods Genetics

coronary heart disease symptoms

Symptoms: Angina, shortness of breath, fatigue, arrhythmia, light-headedness, and peripheral edema Sometimes no symptoms

coronary heart disease

The clogging of the vessels that nourish the heart muscle - Main cause is atherosclerosis

monitoring management for obesity

Track food intake, physical activity, and weight throughout the treatment process Data beneficial for individual and healthcare provider - Allows for review of information recorded Recent study found that mobile apps for dietary tracking that incorporate individualized goal setting can produce clinically significant weight loss Recording time or steps also beneficial Patients must undertake measurements of weight changes over time to ensure they are achieving or maintaining weight targets.

Management of diverticular disease

Treated with oral antibiotics, anti-inflammatory medication, and low-fiber diet when symptoms are acute - Hospitalization with more severe symptoms Dietary recommendations for diverticulitis - Nothing by mouth until tests conducted - Rest bowel, then add clear fluids - Enteral nutrition may be necessary Dietary recommendations for diverticulosis - High-fiber, adequate fluid diet - Possible vitamin supplementation and probiotics

management of cardiovascular disease: treatment goals

Treatment goals: - Reduce heart's workload by controlling blood pressure - Use beta blockers or calcium channel blockers to decrease intensity of heart pumping - Might also prescribe anticoagulants, aspirin, antiplatelet drugs, angiotensin-converting enzyme (ACE) inhibitors, and statins Other possible treatments: - Angioplasty or coronary artery bypass grafting - Dietary treatment to lower LDL cholesterol and raise HDL cholesterol Weight loss if needed Increase physical activity

prevention of type 2 diabetes

Weight loss if obese - Large waist circumference associated with type 2 diabetes, heart disease, and high blood pressure - Weight reduction using intensive lifestyle intervention reduces incidence of diabetes by 58%.

risk factors for obesity: unhealthy eating

Whole grains, vegetables, fruits, and nuts associated with helping people maintain control of their weight - Refined grains and sugary beverages associated with increased disease risks and weight gain Childhood dietary patterns affect people in adulthood Input-output analysis for weight management suggests exercising more and eating less can help manage obesity Many health professionals endorse governments promoting policy and environmental changes to: - Make healthy foods more accessible - Decrease availability and marketing of unhealthy foods

medical complications of obesity: gynecology

abnormal menses infertility polycystic ovarian syndrome

medical complications of obesity: cancer

breast uterus cervix prostate kidney colon esophagus pancreas liver

diverticular disease

condition in which bulging pouches (diverticula) in the gastrointestinal (GI) tract push the mucosal lining through the surrounding muscle

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries major cause of aneurysms in descending thoracic aorta Lining of aorta becomes covered with plaque Oxygen and nutrients can't get through to cells Cells die and aortic wall weakens Pressure in blood vessels causes walls to expand in area of plaque and aneurysm occurs

medical complications of obesity: heart

coronary heart disease dyslipidemia hypertension

medical complications of obesity: liver

nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis

medical complications of obesity: lungs

pulmonary disease -abnormal function -obstructive sleep apnea -hypoventilation syndrome

medical complications of obesity: brain

stroke idiopathic intracranial hypertension