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Chapter 2 Guidelines for Designing a Healthy Diet.

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1 Chapter 2 Guidelines for Designing a Healthy Diet

2 Chapter Outline Diet planning principles (2.1) Diet planning principles (2.1) Evaluating nutritional health (2.2, 2.3) Evaluating nutritional health (2.2, 2.3) Levels of nutritional status Levels of nutritional status Deficiencies Deficiencies Food Guides – skip pages Food Guides – skip pages Using My Plate (2.4 & Myplate.gov) Using My Plate (2.4 & Myplate.gov) Nutritional recommendations – DRI (2.5) Nutritional recommendations – DRI (2.5) Science behind nutritional research (2.6) Science behind nutritional research (2.6) Food labels (2.7) Food labels (2.7) Health Claims Health Claims

3 Planning a Healthy Diet Adequate Diet is a diet that provides enough energy to maintain a healthy diet and provides nutrients needed for optimal health Adequate Diet is a diet that provides enough energy to maintain a healthy diet and provides nutrients needed for optimal health General philosophy for an adequate diet….Eat a variety of foods in moderation. General philosophy for an adequate diet….Eat a variety of foods in moderation.

4 Diet-Planning Principles (5) 1. Balance 2. Variety 3. Nutrient density 4. Energy density – Kcal control 5. Moderation

5 Diet-Planning Principles Balance Balance Diet that provides enough, but not too much of each type of food Diet that provides enough, but not too much of each type of food Dont want overeating of one food type to crowd out intake of other nutrients….Dont want overeating of one food type to crowd out intake of other nutrients….

6 Diet-Planning Principles Variety - Variety - Diet that includes a wide selection of foods within each food group Eat a variety of fruits, not just orangesEat a variety of fruits, not just oranges Why?Why? Variety within the fruit and vegetable groups has the added bonus of increasing the variety of phytochemicals in your diet. Variety within the fruit and vegetable groups has the added bonus of increasing the variety of phytochemicals in your diet.

7 Phytochemicals Phytochemicals – substances in plants that may contribute to health Phytochemicals – substances in plants that may contribute to health Examples – see page 12 Examples – see page 12 Functional Foods – foods that provide health benefits beyond those of the known nutrients Functional Foods – foods that provide health benefits beyond those of the known nutrients

8 Diet-Planning Principles Nutrient Density Nutrient Density Select foods that provide the most nutrients for the least number of calories (nutrient dense foods) Select foods that provide the most nutrients for the least number of calories (nutrient dense foods) Skim milk versus soda (page 40)Skim milk versus soda (page 40) Foods with few nutrients and many calories are sources of empty calories.Foods with few nutrients and many calories are sources of empty calories.

9 Diet-Planning Principles Energy Density - Kcal Control Energy Density - Kcal Control Foods with low-energy density have low kcal per gram, page 41 Foods with low-energy density have low kcal per gram, page 41 Can eat a lot without many caloriesCan eat a lot without many calories Select foods with low energy density for an intake that meets nutritional needs without excess kcal intake Select foods with low energy density for an intake that meets nutritional needs without excess kcal intake

10 Energy Density Measure of the kcal per gram of food Measure of the kcal per gram of food _______ has the highest energy density of the 3 energy-yielding nutrients. _______ has the highest energy density of the 3 energy-yielding nutrients. Foods with a high energy density Foods with a high energy density provide more kcal per gram than low density foods. provide more kcal per gram than low density foods. 10

11 Energy Density 11

12 Diet-Planning Principles Moderation Moderation Eat moderate (small) portion sizes Eat moderate (small) portion sizes Moderate your intake of foods high in: Moderate your intake of foods high in: Added sugarsAdded sugars SaltSalt Saturated and trans fatsSaturated and trans fats CholesterolCholesterol AlcoholAlcohol

13 Diet-Planning Principles (5) 1. Balance 2. Variety 3. Nutrient density 4. Energy density – Kcal control 5. Moderation

14 Levels of Nutritional Status Desirable/Ideal nutrition Intake is sufficient to meet daily needs and to keep nutritional stores full while maintaining a healthy body weight

15 Levels of Nutritional Status Borderline nutrition – a subset of undernutrition in text Intake is not sufficient to meet daily needs Drawing upon your stores Body is not prepared to handle times of stress Illness, pregnancy… May slows growth and development of fetus and growing child

16 Levels of Nutritional Status Undernutrition Intake does not meet daily caloric and nutrient needs and nutrient reserves are empty for some/all nutrients There is a decline in body functions due to the lack of nutrients Can be life threatening Medical intervention required

17 Nutritional Deficiencies Covert vs. overt deficiency Covert vs. overt deficiency Covert or sub-clinical – deficiency may be detected by lab tests, but not outward signs of the deficiency Covert or sub-clinical – deficiency may be detected by lab tests, but not outward signs of the deficiency Overt or clinical symptoms– outward signs of the deficiency Overt or clinical symptoms– outward signs of the deficiency

18 Nutritional Deficiencies Primary vs. secondary deficiency Primary vs. secondary deficiency Primary – inadequate intake of the nutrient Primary – inadequate intake of the nutrient Secondary – body doesnt absorb adequate amounts, excretes too much…. Secondary – body doesnt absorb adequate amounts, excretes too much…. Body mishandles the nutrientBody mishandles the nutrient Diet history helps distinguish between these Diet history helps distinguish between these

19 Under-nourished Populations at increased risk: anyone living in poverty especially infants, children, pregnant women, elderly elderly in general, including those living in nursing homes pregnant teens drug and alcohol addicts individuals with eating disorders anyone with prolonged illness, including hospital patients

20 Overnutrition Over-nutrition – 2 aspects Over-nutrition – 2 aspects excessive caloric intake that leads to obesity excessive caloric intake that leads to obesity Increase risk of obesity related diseasesIncrease risk of obesity related diseases heart disease, diabetes…. heart disease, diabetes…. overuse of vitamin supplements that leads to toxicity overuse of vitamin supplements that leads to toxicity

21 Malnourished Comment on a commonly used term…. Comment on a commonly used term…. The term malnourished is most commonly used in reference to chronic under- nutrition The term malnourished is most commonly used in reference to chronic under- nutrition It can also be used in reference to anyone with chronic poor nutrition that results in failing health It can also be used in reference to anyone with chronic poor nutrition that results in failing health

22 Evaluating Nutritional Status 1. Background - Personal History SESSES Social history - living situation, marital statusSocial history - living situation, marital status Personal and family health historyPersonal and family health history Medications, supplements takenMedications, supplements taken Educational level…..Educational level….. 2. Anthropometric data (A) –Height and weight –Waist circumference –% body fat

23 Evaluating Nutritional Status 3. Biochemical Assessment (B) Laboratory tests, eg –Cholesterol level –Iron, potassium, vitamin D levels –Liver enzyme function 4. Clinical Assessment (C) Physical exam Physical exam –Hair, skin, eyes, tongue… –Blood pressure

24 Evaluating Nutritional Status 5. Diet History (D) -Typical foods eaten -Food journal 6. Environmental Assessment (E) – part of background/personal history

25 The abcs of evaluating nutritional status Anthropometric data Anthropometric data Biochemical tests Biochemical tests Clinical assessment Clinical assessment Dietary intake Dietary intake Environmental status Environmental status Living conditions….from background information see page 43 Living conditions….from background information see page 43

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27 Diet Planning Guides Food Group Plans Foods within each food group provide similar nutrients and are from similar food sources Plan recommends the amount of food to be eaten in each food group. Food Group Plans include: USDA Food Guide (Pyramid/MyPlate) DASH diet

28 See board for updates! Old Food Pyramid

29 2005 USDA Food Guide -MyPyramid

30 Food Pyramid My Plate (6/11) My PlateMy Plate

31 USDA Food Guide Assigns foods to 5 (6?) major food groups Recommends daily intake levels from each group Recommendations vary depending on caloric needs Recommends weekly intake goals for several food groups.

32 My Plate - Grains Grains 5-8 ounces bread, pasta, cereal, rice 5-8 ounces bread, pasta, cereal, rice Half should be from whole grains Half should be from whole grains 1 slice of bread 1 slice of bread ½ English muffin, bun ½ English muffin, bun ½ cup cooked rice, pasta, cereal ½ cup cooked rice, pasta, cereal 1 ounce dry cereal 1 ounce dry cereal

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34 Fruits and Vegetables Make half your plate fruits and vegetable! Make half your plate fruits and vegetable!

35 My Plate - Vegetables Vegetables 2-3 cups vegetables 2-3 cups vegetables Choose a variety from all 5 subgroups weekly (see next slide) 1 cup cooked or raw vegetables 1 cup cooked or raw vegetables 2 cups leafy vegetables (raw) 2 cups leafy vegetables (raw) ¾ cup vegetable juice ¾ cup vegetable juice

36 Eat a Variety of Vegetables Vegetable subgroups 1. 1.Dark green – broccoli and dark greens 2. 2.Red, orange, yellow – carrots, peppers, winter squash, sweet potatoes 3. 3.Legumes – black beans, kidney beans, soybeans, navy beans… Starchy – corn, peas, potatoes, lima beans 5. 5.Other – green beans, brussel sprouts, mushrooms, tomatoes, vegetable juices…

37 My Plate - Fruits Fruits 1 – 1 ½ cups of fruit 1 – 1 ½ cups of fruit Consume a variety of fruits No more than 1/3 from juices 1 orange, apple, banana (all medium size) 1 orange, apple, banana (all medium size) ½ grapefruit ½ grapefruit ½ cup canned fruit or berries ½ cup canned fruit or berries 3/4 cup fruit juice 3/4 cup fruit juice

38 My Plate - Dairy 3 cups/serving dairy 3 cups/serving dairydairy Choose low/no-fat options 1 cup milk 80 kcal, skim 100 kcal, 1% milk 159 kcal, whole milk 1 cup yogurt 1 ½ ounces cheese (170 kcal for cheddar) Calcium enriched soy milk

39 Food Plate - Proteins Proteins 5-6 ½ ounces meat and meat alternatives 5-6 ½ ounces meat and meat alternatives Meat, poultry, fish, eggs, seeds, nuts, legumes – ounce equivalents Meat, poultry, fish, eggs, seeds, nuts, legumes – ounce equivalents ½ ounce nuts½ ounce nuts 1 egg1 egg 1/4 cup cooked legumes = 1 ounce1/4 cup cooked legumes = 1 ounce 1 tablespoon pb1 tablespoon pb

40 My Plate - Oils Oils Oils – 5-7 teaspoons per day Oils – 5-7 teaspoons per day Olive oil Olive oil Canola oil Canola oil Corn oil Corn oil Vegetable oil Vegetable oil

41 My Plate – Empty Calories Empty CaloriesEmpty Calories Fats and sugars – eat sparingly Fats and sugars – eat sparingly Butter, margarine Butter, margarine Cream, sour cream, cream cheese, mayo. Cream, sour cream, cream cheese, mayo. Candy, soda, sugar, honey…. Candy, soda, sugar, honey…. Sports drinks, energy drinks Sports drinks, energy drinks

42 My Plate Strengths: Strengths: Drawbacks: Drawbacks:

43 Putting the Plan into Action Copyright 2005 Wadsworth Group, a division of Thomson Learning

44 MyPlate Physical Activity Physical Activity Physical Activity Physical Activity Adults should do at least 2 hours and 30 minutes each week of aerobic physical activity at a moderate level Adults should do at least 2 hours and 30 minutes each week of aerobic physical activity at a moderate levelOR 1 hour and 15 minutes each week of aerobic physical activity at a vigorous level. 1 hour and 15 minutes each week of aerobic physical activity at a vigorous level.

45 Science Of Nutrition Nutritional recommendations are based on scientific research. Nutritional recommendations are based on scientific research. Recommendations attempt to define adequate intake. Recommendations attempt to define adequate intake.

46 Dietary Recommendations Dietary Reference Intakes (DRI) 1. EAR - Estimated Average Requirements 2. RDA – Recommended Dietary Allowances 3. AI – Adequate Intake 4. UL – Tolerable Upper Intake Levels All based on nutritional research.

47 EAR and RDA 1. Estimated Average Requirements Intake amount that appears to meet the needs of 50% of the population Intake amount that appears to meet the needs of 50% of the population Age, gender, condition basedAge, gender, condition based Set after review of many research studiesSet after review of many research studies 2. Recommended Dietary Allowances RDA is set to meet the needs of 98% of the population (without reaching toxic levels) RDA is set to meet the needs of 98% of the population (without reaching toxic levels)

48 DRI

49 AI 3. Adequate Intake (AI) AI = average amount of the nutrient that a group of healthy people consume AI = average amount of the nutrient that a group of healthy people consume AI is set when there isnt enough research to set an estimated average requirement (EAR) or RDA AI is set when there isnt enough research to set an estimated average requirement (EAR) or RDA Examples: Vitamin D, water, fiberExamples: Vitamin D, water, fiber

50 UL 4. Tolerable Upper Intake Level (UL) Maximum daily amount of nutrient that appears safe for most healthy people Maximum daily amount of nutrient that appears safe for most healthy people Intake above the UL is associated with toxicity symptoms Intake above the UL is associated with toxicity symptoms Most often see with overuse of supplements or intake of many fortified foodsMost often see with overuse of supplements or intake of many fortified foods

51 DRI

52 Other Recommendations Estimated Energy Requirements (EER) Estimated Energy Requirements (EER) Caloric intake that will maintain energy balance in a healthy person Caloric intake that will maintain energy balance in a healthy person Values given are for reference male and female who is fairly activeValues given are for reference male and female who is fairly active Values are not very useful for individuals! Values are not very useful for individuals!

53 Energy – Why not set an RDA?

54 Other Recommendations Acceptable Macronutrient Distribution Range Acceptable Macronutrient Distribution Range or, recommended intake of energy yielding nutrients or, recommended intake of energy yielding nutrients 45-65% of caloric intake from carbohydrate45-65% of caloric intake from carbohydrate 20-35% of caloric intake from fat20-35% of caloric intake from fat 10-35% of caloric intake from protein10-35% of caloric intake from protein

55 The Science of Nutrition One of the newest sciences One of the newest sciences New branch is nutritional genomics New branch is nutritional genomics Study of the interaction of nutrients with DNA/genes and how those genes impact healthStudy of the interaction of nutrients with DNA/genes and how those genes impact health Like all sciences, nutrition is based on scientific research Like all sciences, nutrition is based on scientific research

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57 Scientific Method 1. Observations Questions 2. Hypotheses Predictions 3. Test hypotheses/predictions 4. Analyze data and draw conclusions 5. Share results Page 64 Page 64

58 Observations and Questions Make observations about diet and health. These observations lead to questions Make observations about diet and health. These observations lead to questions For example: The incidence of breast cancer is much lower in Japan than in the U.S. The incidence of breast cancer is much lower in Japan than in the U.S. Diet in Japan is rich in…..while in U.S. diet is rich in …… Diet in Japan is rich in…..while in U.S. diet is rich in …… Question?: Question?:

59 Develop Hypotheses and Make Predictions Hypothesis – tentative explanation of the observations or answer to the question Hypothesis – tentative explanation of the observations or answer to the question Make prediction – If the hypothesis is true what else is true? Make prediction – If the hypothesis is true what else is true?

60 Experiments Conduct experiments to test the predictions Conduct experiments to test the predictions Easier said than done when people are involved! Easier said than done when people are involved! Well consider research designs later/soon. Well consider research designs later/soon.

61 One Experimental Design When possible, randomly assign subjects to either a control of experimental group When possible, randomly assign subjects to either a control of experimental group Goal is for two groups to be as similar to each other as possible Goal is for two groups to be as similar to each other as possible Control Group – either no change to diet or given a placebo Control Group – either no change to diet or given a placebo Experimental group – diet changed or given a supplement Experimental group – diet changed or given a supplement

62 Experimental Design Compare the health/lab values of the two groups before and after the diet change. Compare the health/lab values of the two groups before and after the diet change. Example – DASH diet study Example – DASH diet study

63 Analyze results… Analyze results Analyze results Draw conclusions about the validity of the hypothesis Draw conclusions about the validity of the hypothesis Test alternate hypotheses Test alternate hypotheses Share findings Share findings Publish in nutritional journals Publish in nutritional journals Present findings at conferences Present findings at conferences

64 Common Research Designs 1. Epidemiological study (observe) Cross-sectional Cross-sectional Longitudinal Longitudinal Case-control study Case-control study 2. Experimental (intervene) Animal studies Animal studies Human clinical trials Human clinical trials Double blind studyDouble blind study Lab studies Lab studies

65 The Science of Nutrition 1. Epidemiological studies Study of populationsStudy of populations Look for correlations between dietary practices and healthLook for correlations between dietary practices and health

66 Epidemiological Studies Cross-sectional - look for correlations between diet and health at a point in time Longitudinal Studies - Follow a group of people (a cohort) over a period of time Look for differences in diet that might account for the differences in healthLook for differences in diet that might account for the differences in health

67 Epidemiological Studies Case-control study – compare the diet of individuals with a condition to that of healthy individuals Case-control study – compare the diet of individuals with a condition to that of healthy individuals Again, do not change their diet…..just observe it. Again, do not change their diet…..just observe it. Go to page 65 if not already there… Go to page 65 if not already there…

68 Human Experimental Studies Often called a Clinical Study Randomly assign like people to either the experimental or control groupRandomly assign like people to either the experimental or control group Alter the diet of experimental group as compared to a control groupAlter the diet of experimental group as compared to a control group Compare incidence of disease/lab values/ performance …. of two groupsCompare incidence of disease/lab values/ performance …. of two groups

69 Types of Clinical Trials Blind experiments Blind experiments Subjects do not know which group they are inSubjects do not know which group they are in Double blind experiments Double blind experiments Neither subjects nor the researchers know which group the subjects are in until after the experiment is overNeither subjects nor the researchers know which group the subjects are in until after the experiment is over Goal is to avoid bias in the reporting/recording of the data.Goal is to avoid bias in the reporting/recording of the data.

70 Experimental Studies Animal Studies Controlled studies in lab setting using animalsControlled studies in lab setting using animals Alter diet of experimental groupAlter diet of experimental group Compare health/lab values of control and experimental groupsCompare health/lab values of control and experimental groups Benefits? ….Benefits? …. Drawbacks? ……Drawbacks? ……

71 Experimental Studies Lab-Based Studies Also called in vitro studiesAlso called in vitro studies Examine impact of a substance on living tissue in a test tubeExamine impact of a substance on living tissue in a test tube

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73 The Science of Nutrition Size matters Size matters Good studies have relatively large sample sizes Good studies have relatively large sample sizes Preliminary studies have smaller sample sizes Preliminary studies have smaller sample sizes Peer review matters Peer review matters Information in peer- reviewed research journals is much more credible than that in popular magazines, TV, Internet Information in peer- reviewed research journals is much more credible than that in popular magazines, TV, Internet

74 Food Labels Ingredient list Listed by weight in product (most to least) Serving size Set by govt for each food type Not the same as the MyPlate serving

75 Food Labels Nutritional content compared to Daily Values Daily Values are estimates of the needs of 2000 kcal per day consumer Not the same as RDA – why?

76 Food Labels Specific nutrition facts Kcal/serving Kcal from fat Total fat, grams and % Daily Value (DV) Grams saturated fat, % DV Grams trans fats – added 2006 Cholesterol (mg and % DV) Sodium (mg and % DV)

77 Food Labels Nutrition Facts, contd Total grams carbohydrate Grams sugar Grams and % DV: fiber Grams protein % DV: Vitamin A Vitamin C Iron Calcium

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79 Food Labels Health claims allowed on food labels are regulated by the FDA Law changed in 2003 to allow more health claims Much more confusing now Now health claims with limited evidence can now be put on labels with a disclaimer/explanation. Pages 68/69

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81 Food Labels

82 Structure-function claims do not require FDA approval Cannot mention a disease or symptom Limited regulation of claims on dietary supplements (since 1994)

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84 Food Labels May reduce the risk of heart disease. A health claim Regulated and needs FDA approval. Promotes a healthy heart. A structure-function claim No FDA approval or proof needed to make

85 Other Recommendations Other countries and international organizations set their own nutritional recommendations Other countries and international organizations set their own nutritional recommendations e.g. World Health Organization (WHO)


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