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Chapter 10:
Special Topics in Adults & Chronic
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
• 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
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
• 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
D. Implications of the Prevention Levels
III. Dietary Guidelines for Disease
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
• 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
• 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
B. Obesity Recommendations
-weight management
C. Cardiovascular Disease
-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
Preventing, delaying, and treating the onset
complications by modifying nutrient intake and
lifestyle to prevent and treat obesity,
cardiovascular disease, hypertension, and
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
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