nutrition for healthy adults darwin deen, md, ms march, 2001

Nutrition for Healthy Adults

Darwin Deen, MD, MS

March, 2001

Nutrition Academic Award

Learning Objectives

• Review the relationship between diet and health for adults.

• Review the USDA’s new Dietary Guidelines for Americans.

• Learn strategies to teach healthy diet to our patients.

• Identify nutrition information from food labels.


Why Should Doctors Be Concerned?

• If my patient is basically healthy, why should I be concerned about their dietary intake?

• The prevalence of obesity is rising dramatically in most Western nations.

• Obesity is causally related to hyperinsulinism, hypertension, and diabetes.


Why Should Doctors Be Concerned?

• Diet and physical activity are linked to more deaths each year than any single factor other than cigarette smoking.

• As health care providers, we can do more for our patients by helping them to eat a healthy diet and exercise regularly than any other intervention.


The American Diet

• What is wrong with the way we eat?– Students of nutrition are keenly aware of the

differences between the way Americans eat and the way most non-Western populations eat.

– These differences are reflected in the mortality patterns in these different populations.

– Western diets contain more calories and more protein, and more of those calories come from saturated and hydrogenated fat.


The American Diet

– Western countries have almost eliminated malnutrition as a pediatric problem. Infant mortality rates due to infectious causes are greatly reduced (due to a combination of improved immune function and hygiene).

– This diet that maximizes growth in children and adolescents begins to work against us as adults when growth is completed.


Indigenous Diets

• Most indigenous populations follow a grain-based diet (wheat, rice, etc.).

• While these diets frequently have inadequate calories for optimal growth (compare the WHO growth curves with our own), if calories are adequate, most have enough protein.

• In America, we have focused on meat for extra protein (cowboys are our icon), but get too much fat as a result (“bringing home the bacon”).


Trends in the American Diet

• In 1976, the Senate Select Committee identified dietary fat as a health risk.

• In 1988, The Surgeon General’s Report on Nutrition and Health identified over consumption of fat as a national priority for dietary change.

• Over the past 30 years fat consumption has decreased from 40% of calories to around 34%.

• The bad news is that calorie consumption is up and energy expenditure is down.


The American Diet

• Too many calories

• Too much fat

• Too much saturated fat

• Too much salt

• Not enough fruits and vegetables

• Not enough fiber

• Not enough exercise


Dietary Guidelines for Americans

• Aim for a healthy weight.

• Be physically active each day.

• Let the pyramid guide your food choices.

• Choose a variety of whole grains daily.

• Choose a variety of fruits and vegetables daily.

• Keep foods safe to eat.


Dietary Guidelines for Americans

• Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.

• Choose beverages and foods to moderate your intake of sugars.

• Choose and prepare foods with less salt.

• If you drink alcoholic beverages, do so in moderation.


The Improved American Diet

• Lower in saturated fat

• Higher ratio of n-3 to n-6 fatty acids

• Avoid trans-fatty acids

• Lower in dietary cholesterol

• Less sodium, more potassium

• More fiber from beans and whole grains


Steps to Improve Current Diet

• Step 1: Assess current diet.

• Step 2: Alter existing recipes, change cooking methods and shopping lists.

• Step 3: Add new foods (fruit snacks, whole grains, etc) and try new recipes.

• Step 4: Learn to maintain new habits at home and when eating out.


Food Guide Pyramid


Adults Not Getting Adequate Fruit & Vegetables*

Living Arrangement

05

1015202530354045

Percent

Men belowpoverty level

Men abovepoverty level

Women belowpoverty level

Women abovepoverty level


Goals of a New Dietary Regimen

• Reduce the risk of chronic diseases:– atherosclerosis – hypertension– diabetes – cancer

• Promote weight loss or weight maintenance.• Improve physical and mental performance.• Promote longevity.


Changing Dietary Behavior

• Complicated by the multidimensional nature of dietary intake:– Social, cultural, and psychological factors– Hunger and satiety– Safety and comfort– Need for basic sustenance

• Requires new knowledge D:\Food Labels.ppt and commitment.


Changing Dietary Behavior

• Intensive behavioral changes should be made slowly in small incremental steps.

• Each small step should be reinforced until maintained.

• Maintenance may be more difficult than the initial change.

• Relapse should be expected and anticipated.• Patients must proceed at their own pace.


References

• The New American Diet. SL Conner & WE Conner 1986 Simon & Schuster

• Bowen DJ Tinker LF. Controversies in Changing Dietary Behavior in Nutrition and Health: Topics and Controversies. Bonner F, ed. 1995 CRC Press.

• Eaton CB, Gans KM. Cardiovascular Disease and Nutrition. Rhode Is Med & Health 2000;83:339-42.

nutrition for healthy adults darwin deen, md, ms march, 2001

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