Chapter 10: Special Topics in Adults & Chronic Diseases: Nutrition and Public Health Judith Sharlin, PhD, RD

Reader Objectives: After studying this chapter and reflecting on the contents, you should be able to: Identify the primary causes of death and disability in adults in the US. Describe primary, secondary and tertiary levels of health prevention and health promotion and its relationship to nutrition program planning. Identify risk factors for chronic diseases and their implication for nutrition. Describe the dietary risk factors associated with the leading chronic diseases.

Reader Objectives, cont. Discuss the common features of the dietary guidelines issued by the major US health organizations. Compare different dietary interventions a public health nutritionist or dietitian offers to the community, family or an individual at risk. Recognize the mission and role of public health nutrition in preventing disease and promoting adult health. Name some of the public health nutrition programs that exist today for maintaining adult health.

I. Preventing Disease and Promoting Health A.Chronic Diseases: The Leading Causes of Death and Disability 1. Risk Factors and Chronic Disease Biological factors such as an individual’s genetic make-up, family history, age, gender; Environmental conditions—social and physical environment; Access to quality healthcare; and, Individual behavior and lifestyle factors such as smoking, exercise, good eating habits.

II. Prevention Strategies in Public Health A.Primary Prevention (Health Promotion) B.Secondary Prevention (Risk Appraisal and Risk Reduction) C.Tertiary Prevention (Treatment and Rehabilitation) D.Implications of the Prevention Levels

III. Dietary Guidelines for Disease Prevention A. Recommendations Consuming a diet that emphasizes whole grains and legumes, vegetables and fruits; Decreasing saturated fat and dietary cholesterol; limiting red meat, and full-fat dairy products; Limit intake of foods and beverages high in added sugars; and, Limit overall intake of calories and engage in regular physical activity to maintain a healthy body weight.

IV. Diet and Health: Nutrition Strategies and Risk Factors A. Nutrition Strategies in Public Health Should Use the Following Criteria: The risk factor must have a strong association with the development of a chronic disease, i.e. obesity and heart disease; The risk factor affects a significant number of people; The risk factor is modifiable, so it can be reduced or changed; and, The risk factor has a modification that, when changed or reduced, results in decreased mortality.

B. Obesity Recommendations -weight management C. Cardiovascular Disease Recommendations -hypertension -cholesterol -physical activity

D. Cancer Recommendations Eat a plant-based diet that includes a wide variety of fruits, vegetables, whole grains, beans and legumes. The recommendation is to choose whole grains over refined sources, and eat three to five servings of vegetables per day, and two to four servings of fruits; Eat less fat from all food sources; Limit excess calories and maintain a healthful weight throughout life. Eat a sound diet and incorporate moderate or vigorous physical activity 5 days a week, or more, to further reduce risks of cancer; and, If you drink alcohol, do so in moderation.

E. Diabetes Recommendations Attaining and maintaining optimal metabolic outcomes including normalizing blood glucose levels, a lipid profile that reduces vascular disease risk, and normalizing blood pressure levels; Preventing, delaying, and treating the onset complications by modifying nutrient intake and lifestyle to prevent and treat obesity, cardiovascular disease, hypertension, and nephropathy;

E. Diabetes Recommendations, cont. Optimizing health through sensible food choices and physical activity; and, Addressing personal and cultural preferences, as well as lifestyle factors, including a person’s willingness to change when determining individual nutritional needs.

F. Osteoporosis Recommendations 1.a diet rich in calcium and vitamin D; 2.weight-bearing exercise; 3.a healthy lifestyle that excludes smoking and excessive alcohol intake; 4.routine bone density measurements; and, 5.the use of medication, when appropriate.

G. Acquired Immune Deficiency Syndrome (AIDS) Public Health Issues Healthful eating principles, Water and food safety issues, Perinatal and breast-feeding issues, Nutrition management for symptoms such as anorexia, swallowing problems, diarrhea, etc., Food medicine interactions, Psychosocial and economic issues,

G. (AIDS) Public Health Issues, cont. Alternative feeding methods (supplementation, tube feeding, or parenteral nutrition), Additional therapies including physical activity and disease management, Guidelines for evaluating nutrition information and diet claims, individual mineral and vitamin supplementation, and Strategies for treatment of altered fat metabolism.

Issues for Discussion What would you propose should be incorporated into public health programs that focus on nutrition as an important preventive factor in illness, disability and death? What advice would you give to the individual in the community with regard to preventing chronic disease risk factors such as obesity, physical inactivity and smoking in order to reduce society’s financial burden?

Issues for Discussion, cont. What proportion of public funds designated for nutrition services should be given for primary, secondary, and tertiary prevention versus acute medical care? Programs such as for-profit weight loss centers are proliferating in this country. What are positive and negative aspects of this trend compared with public health weight management programs?