Clinical Nutrition: Objectives

1. 
   Understand the role of diet in preventing and controlling morbidity and premature mortality from chronic disease.
   
   1. 
      1200 deaths/day attributed to unhealthy eating and physical inactivity
      
   2. 
      80% CVD, 90% Type II Diabetes, and 30% cancers could be prevented with healthy weight, healthy diet, and regular exercise throughout lifetime
      
2. 
   Explain the relationship between the diet and physical activity on health.
   
   1. 
      Both affect energy balance, body composition, and interact via metabolic pathways
      
   2. 
      They are both modifiable
      
   3. 
      Sugar increases triglycerides levels
      
   4. 
      Saturated fats increases cholesterol levels
      
      1. 
         Depresses the activation of PPARa (makes fat cells lazy and store more fat)
         
         1. 
            Increases inflammation
            
   5. 
      Gene expression is affected by diet
      
3. 
   Describe the effect of body weight on health.
   
   1. 
      Low birth weight and obesity as an adult is at the highest risk of chronic disease
      
   2. 
      Large birth size increases risk of heart disease, diabetes, and breast/uterine cancers
      
   3. 
      Fat Distribution affects morbidity due to obesity as well.
      
      1. 
         Android is the worst. That is belly fat (think andy is a boys name and therefore is more predominant in men; also more common in post menopausal women)
         
      2. 
         Gynoid is the pear shaped fat. Its more common in women. Its in the area of thighs and butt. (think gynecology is in that area)
         
4. 
   Describe the diet recommendations related to:
   
   1. 
      Diabetes:
      
      1. 
         FACTORS THAT INCREASE RISK OF DIABETES
         
         1. 
            HALO M
            
            1. 
               High Fat/High Sat Fat
               
            2. 
               Abdominal Obesity
               
            3. 
               Lack of Physical Activity
               
            4. 
               Overweight
               
            5. 
               Maternal Diabetes
               
      2. 
         FACTORS THAT DECREASE RISK OF DIABETES
         
         1. 
            WADS
            
            1. 
               Weight loss
               
            2. 
               Activity
               
            3. 
               Dietary Fiber (increase it)
               
            4. 
               Sat Fat (decrease it)
               

2. 
   Cancer: diet is a factor in 30% of cancers
   
   1. 
      Obesity is linked with increased IGF-1 which activates Akt. Akt prevents Apoptosis (Cancer is the uncontrolled cell growth)
      
   2. 
      Summary to reduce Risk
      
      1. 
         Eat a healthy diet with an emphasis on Plant Foods
         
      2. 
         5 or more servings of a variety of fruits and vegetables
         
      3. 
         Whole grains instead of processed or refined
         
      4. 
         Limit consumption of processed and red meat
         
      5. 
         Limit alcohol intake
         
3. 
   Hypertension:
   
   1. 
      Greatly increases risk of early mortality.
      
   2. 
      Sodium restriction reduce blood pressure in 30-60% of patients
      
   3. 
      Sodium restriction also increases the efficacy medicine
      
   4. 
      Salt sensitivity is increased by:
      
      1. 
         Age (older)
         
      2. 
         Gender (women)
         
      3. 
         Ethnicity (African American)
         
      4. 
         Renal insufficiency
         
   5. 
      Sodium increases water retention and calcium excretion in urine
      
      1. 
         Ca is very important in blood pressure regulation
         
   6. 
      Foods high in sodium usually low in K
      
   7. 
      Diet:
      
      1. 
         Reduce Na
         
      2. 
         Maintain K, Ca, and Mg
         
      3. 
         Reduce Sat fat and cholesterol intake
         
      4. 
         Limit alcohol intake
         
   8. 
      Behavior:
      
      1. 
         Weight loss
         
      2. 
         Increase aerobic activity
         
      3. 
         Stop smoking
         
   9. 
      DASH Diet
      
      1. 
         Combination of a variety of fruits and vegetables with low fat and saturated fat had largest effect.
         
         1. 
            Increased calcium potassium and magnesium(all affect BP)
            
         2. 
            Lowers fat and cholesterol intake
            
         3. 
            Increases phytonutrients
            
         4. 
            Increases Fiber
            

1. 
   LEARN THIS
   
   1. 
      7-8 grains
      
   2. 
      4-5 fruits
      
   3. 
      4-5 vegetables
      
   4. 
      4-5 nuts/seeds
      
   5. 
      2-3 non fat dairy
      
   6. 
      2 of lean meat
      
   7. 
      low fat
      
   8. 
      No more than 5 sweets per week
      
1. 
   Osteoporosis:
   
   1. 
      Increased risk factors
      
      1. 
         Age
         
      2. 
         Gender
         
      3. 
         Race
         
      4. 
         Family History
         
      5. 
         History of breaks
         
      6. 
         Bone structure and body weights
         
      7. 
         Early menarche/Post Menopausal
         
      8. 
         Cigarettes, alcohol, decreased weight bearing exercise, low calcium and vitamin D
         
   2. 
      Over 65 years old—1500 mg Ca QD
      
   3. 
      Post Menopausal under 65—1500 mg Ca and 400-800 IU of Vit D QD
      
   4. 
      Premenopausal 25-50—1000 mg Ca and 400 Vit D QD
      
2. 
   WHO Recommended Diet
   
   1. 
      20-30% Fat
      
      1. 
         less than 10% saturated fat
         
      2. 
         less than 300 mg cholesterol
         
   2. 
      45-65% Carbohydrates
      
      1. 
         less than 10% added sugar
         
      2. 
         25 grams fiber
         
   3. 
      10-15% Protein
      
   4. 
      2300 mg sodium
      

North Karelia, Finland: CVD dropped dramatically in 20 years because of better diets

Republic of Korea: Industrialized nation which has maintained traditional vegetable based diet

Lifestyle changes (diet and exercise) can cause metabolic syndrome to go away (41% people)

BMI: index of wt/ht (does not consider amount of fat, only weight – but is accurate enough for many people)

Normal BMI: 18.5-24.9