1. Nutrition for Healthy Adults Darwin Deen, MD, MS March, 2001

2. 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.

3. Nutrition Academic Award 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.

4. Nutrition Academic Award 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.

5. Nutrition Academic Award 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.

6. Nutrition Academic Award 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.

7. Nutrition Academic Award 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”).

8. Nutrition Academic Award 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.

9. Nutrition Academic Award 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

10. Nutrition Academic Award Dietary Guidelines for Americans 1.Aim for a healthy weight. 2.Be physically active each day. 3.Let the pyramid guide your food choices. 4.Choose a variety of whole grains daily. 5.Choose a variety of fruits and vegetables daily. 6.Keep foods safe to eat.

11. Nutrition Academic Award Dietary Guidelines for Americans 7.Choose a diet that is low in saturated fat and cholesterol and moderate in total fat. 8.Choose beverages and foods to moderate your intake of sugars. 9.Choose and prepare foods with less salt. 10.If you drink alcoholic beverages, do so in moderation.

12. Nutrition Academic Award 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

13. Nutrition Academic Award 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.

14. Nutrition Academic Award Food Guide Pyramid

15. Nutrition Academic Award Adults Not Getting Adequate Fruit & Vegetables*

16. Nutrition Academic Award 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.

17. Nutrition Academic Award 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.D:\Food Labels.ppt

18. Nutrition Academic Award 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.

19. Nutrition Academic Award 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.