Chapter 2. Designing a Healthy Dietary Pattern Assignment

energy density

A comparison of the calorie (kcal) content of a food with the weight of the 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 in general, and even 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

Which deficiencies are still a problem?

Marginal deficiencies of calcium, iron, folate and other B vitamins, vitamin C, vitamin D, vitamin E, potassium, magnesium, and fiber are still a problem; but for many North Americans, major health problems stem from overconsumption of one or more of the following: calories, added sugars, saturated fat, trans fat, alcohol, and sodium.

subclinical

Stage of a disease or disorder not severe enough to produce symptoms that can be detected or diagnosed. A subclinical deficiency can go on for some time before clinicians are able to detect its effects.

How do you improve nutritional status and overall health?

To improve nutritional status and overall health, the Dietary Guidelines promote the consumption of vegetables, fruits, whole grains, fat-free or low-fat dairy, seafood, lean meats and poultry, eggs, beans and peas, nuts and seeds, and oils, without exceeding calorie needs. This type of dietary pattern will (1) contribute to nutrient adequacy; (2) lower intake of problem nutrients; (3) improve gastrointestinal function; (4) aid in weight management; and (5) decrease risk for chronic diseases.

nutrient density

the ratio derived by dividing a food's nutrient content by its calorie content. When the food's contribution to our nutrient need for that nutrient exceeds its contribution to our calorie need, the food is considered to have a favorable nutrient density. 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 a nutrient for a relatively small amount of calories when compared with other food sources. The higher a food's nutrient density is, the better it is as a nutrient source.

What is a healthy dietary pattern?

A healthy dietary pattern does not have to mean deprivation and misery; it simply requires some basic nutrition know-how and planning. Besides, eliminating favorite foods typically does not work for "dieters" in the long run. The best plan consists of learning the basics of a healthful dietary pattern: variety, moderation, and proportionality.Monitoring total calorie intake is also important for many of us, especially if unwanted weight gain is taking place.

What are the five foundational guidelines of the 2015-2020 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.

Daily Value (DV)

A 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. DVs have been set for vitamins, minerals, protein, 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.

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.

The Assessments in order.

Anthropometric assessment of height, weight (and weight changes), skinfold thicknesses, and body circumferences provide information about the current state of nutrition. Most measures of body composition are easy to obtain and are generally reliable. However, 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. A clinical assessment would follow, during which a health professional would search for any physical evidence (e.g., high blood pressure) of diet-related diseases or deficiencies. Then, a close look at the person's dietary pattern (dietary assessment), including a record of at least the previous few days' food intake, would help to determine any possible problem areas. Finally, adding the environmental assessment (from the background analysis) provides further details about the living conditions, education level, and ability to purchase and prepare foods needed to maintain health. Now the true nutritional state of a person emerges. Taken together, these five assessments form the ABCDEs of nutritional assessment: anthropometric, biochemical, clinical, dietary, and environmental

suggestions that should help you make 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 Disreputable publication sources Promises of dramatic 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 a closely allied 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 what proven techniques are available. They do not ignore reliable cures. Is the claim touted as a new or secret scientific breakthrough?

Balance

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.

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 kilocalorie 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. While a slight excess of vitamins and minerals is Page 62 not harmful, a long-term excess of even a small amount of kilocalories will lead to weight gain. Therefore, the calculation of EER needs to be more specific, taking into account age, gender, height, weight, and physical activity. Note that the EER is based on the "average" person. Thus, it can only serve as a starting point for estimating kilocalorie needs.

dietary assessment

Estimation of typical food choices relying mostly on the recounting of one's usual intake or a record of one's previous days' intake.

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.

undernutrition

Failing health that results from a longstanding dietary intake that is not enough to meet nutritional needs. Undernutrition occurs when nutrient intake does not meet nutrient needs.

malnutrition

Failing health that results from longstanding dietary practices that do not coincide with nutritional needs.

MyPlate 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 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 2015-2020 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.

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.

Healthy Habits

Maintained a healthy dietary pattern: Varied Included some fish Rich in fiber Low in animal fat and trans fat Maintained a healthy weight Occasionally consumed alcohol in small amounts Exercised for at least 30 minutes daily Avoided use of tobacco

Tolerable Upper Intake Levels (Upper Levels or ULs)

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. A Tolerable Upper Intake Level (Upper Level or UL) has been set for some vitamins and minerals. 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. These amounts generally should not be exceeded day after day, as toxicity could develop. For people eating a variety of foods and/or using a balanced multivitamin and mineral supplement, exceeding the UL is unusual. Problems are more likely to arise with dietary patterns that promote excessive intakes of a limited variety of foods, with the use of many fortified foods, or with excessive doses of individual vitamins or minerals.

biochemical assessment

Measurement of biochemical functions (e.g., concentrations of nutrient by-products or enzyme activities in the blood or urine) related to a nutrient's function. 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, circumferences, and thicknesses of parts of the body. The measurement of height, weight (and weight changes), skinfold thicknesses, and body circumferences provide information about the current state of nutrition.

Moderation

Not too much or too little of something; not going to an extreme in your pursuit of a goal. Eating in moderation requires paying attention to portion sizes and planning your daily eating pattern so that you do not overconsume any nutrients. It is especially important to choose foods that help you limit intake of animal fat, added sugars, salt, and alcohol.

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. 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. A Recommended Dietary Allowance (RDA) is the daily amount of a nutrient that will meet the needs of nearly all individuals (about 97%) in a particular age and gender group. A person can compare his or her daily intake of specific nutrients to the RDA. Although an intake slightly above or below the RDA for a particular nutrient on any given day is no reason for concern, a 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.

Proportionality

Proportionality, also referred to as balance, is eating more of nutrient-dense foods and beverages such as fruits, vegetables, whole grains, and fat-free or low-fat milk products, and less of foods high in certain types of fat, sugars, cholesterol, salt, and alcohol.

What is the approach to finding answers about your nutritional state?

Remember from the Ask the RDN in Chapter 1 that the best approach to finding answers about your nutritional state is to consult your primary care provider or registered dietitian nutritionist first

Dietary Reference Intakes (DRIs)

Term used to encompass nutrient recommendations made by the Food and Nutrition Board of the Institute of Medicine. Included under the DRI umbrella are Recommended Dietary Allowances (RDAs), Adequate Intakes (AIs), Estimated Energy Requirements (EERs), and Tolerable Upper Intake Levels (Upper Levels or ULs)

What is the most common form of overnutrition in developed nations?

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.

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.

What is the nutritional state for a particular nutrient that is desirable?

The nutritional state for a particular nutrient is desirable when body tissues have enough of the nutrient to support normal metabolic functions and surplus stores that can be used in times of increased need. A desirable nutritional state can be achieved by obtaining essential nutrients from a variety of foods.

What will be the effect of regular physical activity?

The overarching idea is that regular physical activity—for people of all ages, races, ethnicities, and physical abilities—produces long-term health benefits.

What is the type of standard set for nutrients ?

The type of standard set for nutrients depends on the quality of available evidence. A nutrient recommendation backed by lots of experimental research will be expressed as an RDA. For a nutrient that still requires more research, only an AI is presented. We use the EER as a starting point for determining calorie needs. Some nutrients also have a UL if information on toxicity or adverse health effects is available. Periodically, new DRIs become available as expert committees review and interpret the available research. RDAs and related standards are intended mainly for diet planning. Specifically, a dietary plan should aim to meet the RDA or AI as appropriate and not to exceed the UL over the long term.

What components must be listed on the Nutrition Facts panel?

Total calories (kcal) Calories from fat Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrate Fiber Sugars Protein Vitamin A Vitamin C Calcium Iron

Variety

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.