CHAPTER 1 OVERVIEW OF HEALTHY EATING HABITS Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Role of the Dental Hygienist Identify harmful dietary habits that may initiate oral disease Promote health and wellness as a health professional Opportunity to see patients on a more regular basis than many other health professionals Support interventions initiated by other healthcare professionals Identify patients needing referral to a registered dietitian for complex nutrition needs that may ultimately affect general health 2

3Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Basic Nutrition Nutrition Process by which living things use food to obtain nutrients for energy, growth, and maintenance Essential nutrients Substance obtained from food that the body cannot produce in sufficient quantities to meet physiological requirements

4Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Classes of Nutrients Macronutrients Water* Proteins Carbohydrates Fats Alcohol Micronutrients Minerals Vitamins

5Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Basic Concepts of Nutrition Good nutrition evaluated in context of patient’s: Physiological needs for essential nutrients Nutrient content of the food Cultural or environmental circumstances Personal preferences Encourage variety of foods to minimize nutrient deficiencies or excesses

6Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. US Governmental Nutrition Concerns Before 1977, concern was nutritional deficiencies Current concerns outlined by the Surgeon General include prevention of chronic diseases related to dietary intake, including: Cancers, stroke, diabetes mellitus, atherosclerosis, and coronary heart disease

7Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Objectives involving nutrition include: 22 objectives relate to nutrition/weight; 17 objectives relate to oral health Increase Quality of Life (QoL) & length of lifespan Eliminate health disparities among racial/ethnic groups Create social/physical environments promoting good health Promote QoL, health development, healthy behaviors for all age groups Reduce childhood obesity Increase numbers of community water systems containing optimal amounts of fluoride Increase proportion of children with dental sealants Healthy People 2020 Nutrition Objectives

8Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Dietary Reference Intakes (DRIs) Estimated average requirement (EAR) Amount of nutrients estimated to meet needs of half of healthy individuals in specific age and gender group Recommended dietary allowances (RDAs) Sufficient amount of nutrients to meet requirements of nearly all (97% to 98%) healthy individuals

9Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Dietary Reference Intakes (DRIs) Adequate intake (AI) Average amount of nutrient that appears to maintain a defined nutritional state; more tentative than an RDA Tolerable upper intake level (UL) Maximum daily level of nutrient intake that probably will not cause adverse health or toxic effects for most individuals

10Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Acceptable macronutrient distribution range (AMDR) (see Table 1-1) Ensures sufficient intake of essential nutrients while reducing risk of chronic disease Estimated energy requirement Energy intake that is predicted to maintain energy balance Dietary Reference Intakes (DRIs)

11Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. DRIs: Dental Hygiene Considerations Guidelines apply to average daily intakes Individual’s specific requirement unknown Encourage a variety of healthy food choices DRIs are guidelines for healthy people UL may be used to warn patients against megadoses of nutrients

12Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Dietary Guidelines for Americans 2010 Issued by USDA and HHS; updated every 5 years Authoritative advice for people 2 years and older about how good dietary habits can promote health and reduce risk for major chronic diseases Address diet, physical activity, and other issues promoting healthy eating and food safety U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, th ed. Washington, D.C.: U.S. Government Printing Office, January 2005

13Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Dietary Guidelines for Americans 2010 Key recommendations Adequate nutrients within kilocalorie needs Weight management Physical activity Food groups to encourage Fats and carbohydrates Sodium and potassium Alcoholic beverages Food safety From U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, th ed. Washington, D.C.: U.S. Government Printing Office, January 2005.

14Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Dietary Guidelines for Americans 2010: Dental Hygiene Considerations Apply only to healthy individuals >2 years of age Encourage nutrient-dense food: whole grains, fruits, and vegetables Encourage moderation in salt, sugar, and alcohol intake Encourage intake of fluoridated water

MYPLATE The “MyPlate” structure replaced the previous “Food Pyramid” system; The “MyPlate” structure replaced the previous “Food Pyramid” system; Guidelines are still designed to help Americans choose foods meeting nutritional requirements; promoting health, supporting active lives, and reducing risk for chronic disease Guidelines are still designed to help Americans choose foods meeting nutritional requirements; promoting health, supporting active lives, and reducing risk for chronic disease Nutritional labeling provides additional Nutritional labeling provides additional information about nutrient content information about nutrient content 15Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

16Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Food Pyramid System

17Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Food Pyramid System: Guiding Principles Overall Health Up-to-Date Research Total Diet UsefulRealistic FlexiblePractical Evolutionary

18Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Food Pyramid System MyPyramid was designed to help people make food choices for meeting nutrient requirements Foods are grouped according to nutrient content

19Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Total estimated Discretionary = energy — Essential calories requirement calories Discretionary calories* may be used to: Increase amount of food selected from a food group Increase amount of food selected from a food group Consume foods that are not in the lowest fat form— such as 2% milk or items that contain added sugars Consume foods that are not in the lowest fat form— such as 2% milk or items that contain added sugars Add oil, fat, or sugar to foods Add oil, fat, or sugar to foods Consume alcohol (for those who consume alcohol) Consume alcohol (for those who consume alcohol) Food Pyramid System Message: Discretionary Calories

20Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Food Pyramid System Message: Physical Activity In the Dietary Guidelines: Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight In MyPyramid and MyPlate graphics: Steps and person on them symbolize physical activity should be a part of everyday healthy living

21Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Food Pyramid System Message: Proportionality In the Dietary Guidelines: Adopt a balanced eating pattern Sufficient amount of fruits and vegetables 3 or more ounce equivalents of whole-grain products per day 3 cup equivalents per day of fat-free or low-fat milk or milk products In MyPyramid and MyPlate graphics: Color bands clarify proportionality

22Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Food Pyramid System Message: Moderation In the Dietary Guidelines: Limit intake of saturated and trans fats, and choose products low in these fats Make choices of meat, poultry, dry beans, and milk products that are lean, low fat, or fat free Choose and prepare foods and beverages with little added sugars or calorie sweeteners In MyPyramid and MyPlate graphic: Food group bands narrow from bottom to top suggesting to eat nutrient-dense forms of foods

23Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Food Pyramid and MyPlate Systems: Dental Hygiene Considerations Provide information to patients about relating positive changes in dietary lifestyle changes Use the systems for evaluating adequacy of a patient’s diet Eliminating food groups may lead to inadequate intake of nutrients If only nutrient-dense foods are selected, discretionary kcal can be used on other foods The slogan “Steps to a Healthier You” suggests improvement should happen in stages over time

24Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 1. Start with exercise 2. Focus on food, not grams 3. Go with plants Eat a plant-based diet 4. Cut back on American staples, e.g., red meat, refined sugars, and grains 5. Take a multivitamin and alcohol use in moderation Copyright © 2008 Harvard University. For more information about the Healthy Eating Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health, and Willett W, Skerrett P: Eat, Drink, and Be Healthy. Free Press/Simon & Schuster Inc, Other Food Guides: Healthy Eating Pyramid

25Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Other Food Guides: Eating Well with Canada’s Food Guide Steps toward better health and a healthy body weight include: Eat recommended amount and types of food each day Limit foods and beverages high in calories, fat, sugar, or salt (sodium) Be active every day From Eating Well With Canada’s Food Guide (2007), Health Canada. Reproduced with permission of the Minister of Public Works and Government Services Canada, 2009.

26Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. FDA-Authorized Health Claims Qualified health claims Cancer risk Cardiovascular disease risk Cognitive function Diabetes Hypertension Neural tube birth defects

27Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Daily reference values Based on 2000-calorie diet % DV helps determine if a serving of food is high or low in a nutrient From the Department of Health and Human Services, Food and Drug Administration. How to Understand and Use the Nutrition Facts Label. June 2000, updated July 2003 and November Available: Nutritional Labels

Reading Nutritional Labels Which has more calories? Which one has more saturated fat? Which one has more calcium? From the Department of Health and Human Services, Food and Drug Administration. How to Understand and Use the Nutrition Facts Label. June 2000, updated July 2003 and November Available: Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.28