Lecture 4

Question 1

What is Nutrition?

Answer 1

The science of foods and the substances they contain and their actions within the body (including ingestion, digestion, absorption, transport, metabolism, and excretion)
Nutrition studies the interaction between the individual and the environment mediated by food.
(health behaviours as well as science)

Question 2

What are the components of the “Food” category in the Food Choice Behaviours Diagram?

Answer 2

1. Production (governs in the society that you live. Nz has abundant supply. but other countries have common famine, war etc, therefore have poor access)
2. Distribution
3. Hygiene
4. Preparation
5. Food Labels (colour? information?)
6. Meals
   - Environment category (food we chose to eat)
   - what food influences our choices and behaviours?

Question 3

What are the components of the “Nutrition” category in the Food Choice Behaviours Diagram?

Answer 3

Macronutrients:(provide with energy)
1. Carbohydrates
2. Proteins
3. Fats
Micronutrients: (require small amount daily to be able to metabolise/max energy production + for health)
4. Vitamins
5. Minerals
-Agent (+Diet) category (what we choose to eat)

Question 4

What are the components of the “Body” category in the Food Choice Behaviours Diagram?

Answer 4

1. Genetics (we are what we eat and how it interacts with our genetic makeup)
2. Physiology (digestions, absorption, metbolise nutrients)
3. Lifestyle
4. Needs
   - lifestyle and needs dictate amount and what food required/utilise and amount of vit and minerals)
   - Host category (how our body deals with nutrition and the impact it has on it)

Question 5

When do chronic diseases tend to develop?

Answer 5

After chronic exposure
-middle age
Now mostly Over nutrition or Poor nutrition. Long term exposure over years to that diet.
-really difficult to treat as hard to break/change these entrenched long term lifestyle behaviours, in an environment that isnt conducive to doing so.
-Often associated with number of diseases/appear in clusters (co-morbidities) -CVD + overweight/w. diabetes.
-co-morbidity very often effected by lifestyle/diet

Question 6

What were the type of nutritional diseases in previous years?

Answer 6

ACUTE nutrition problems

• largely due to deficiencies (not over nutrition)
• undernutrition: not getting enough of certain type of nutrient
• Common Goitre :1920s Iodine deficiency, large neck due to protruding thyroid gland, but otherwise had perfectly adequate nutritional status.
• can revert on individual level or improve on population level by adding to a food staple that is commonly eaten (salt)
• -therefore Acute deficiency: something that can be reversed very quickly by understanding deficiency and giving it back the nutrient.
• not seen as much in Developed countries. Now mostly Over nutrition or Poor nutrition. Long term exposure over years to that diet.
• really difficult to treat as hard to break/change these entrenched long term lifestyle behaviours, in an environment that isnt conducive to doing so.

Question 7

What are the components of an individual’s diet?

Answer 7

The foods and beverages one consumes
The quality of which affects quality of life
The quality of which effects the risk of chronic disease

Question 8

Disability Adjusted Life Years

Answer 8

DALY = YLL + YLD

Question 9

YLL

Answer 9

Years of life lost

measures health loss from early death, taking into account the age when death occured

Question 10

YLD

Answer 10

years lived with disability
measures health loss from time spent in less than full health, taking into account the severity off ill health or disability

Question 11

What is the most common causes of death in NZ?

Answer 11

Lung cancer

but DALYs Lost is greater fro Dietary risks than smoking

Question 12

Evolution of lifestyle and dietary intake

Answer 12

Living longer because of better nutrition
-but just dying from different causes
-Paleo “didnt live on processed foods because had to be agile and fit. lots of meat”
-currently less active and fit, different body composition (fat:lean muscle), carb/sugar rich diet + processed food.
Sedentary lifestyles and eating more than we require
Foods are energy rich and poor in nutrients

Question 13

Population guideline requirements

Answer 13

1. Evidence based (use scientific paridigm, try to define gold standard for research which is real, translatable, and biologically plausable, and makes sense in intended population. Hard to do RCT-gold standard. Other things in diet/factors influencing, no true placebo/cannot change significantly enough. difficult to get true evidence base. conflicting advice.
2. Adequate Nutrient Intake
3. Optimise Health
   - safe to consume (low contaminants or potentially harmful added substances: e.g. encourage to eat more foods and vegetables that are good for you, but have to ensure our supply is safe (no pesticides/heavy metal contaminants) so not feeding them contaminants from other sources)
   - guidelines to assist food choices. no individual or cultural requirements taken into consideration.

Question 14

Eating statement 1

Answer 14

1. Plenty of vegetables and fruit
2. Grain foods, mostly whole grain and those naturally high in fibre
3. Some milk and milk products, mostly low and reduce fat
4. Some legumes, nuts seeds, fish and other seafood, eggs, poultry (e.g. chicken) and/or red meat with the fat removed
   - broad, not put in context. High level statements

Question 15

What is the reason for the change from “food and nutrition guidelines” to “eating and activity guidelines”?

Answer 15

Activity is now seen to be just as important as eating

Question 16

Why fruits and vegetables?

Answer 16

The most convincing evidence
Cancer (particularily bowel + hormone cancers (breast, ovarian, prostate)), Weight control ( & better blood-glucose management), CVD
Vitamins C, A, K (water soluble. C=powerful antioxidant. Carotene)
Phytochemicals(Non-nutrients as cant be defined as nutrients. Almost more powerful antioxidants than Vit C. produces Colours of veges.
Minerals (e.g. iron. not huge amounts
Fibre - important for bowel health

Question 17

What are NZ adults doing re fruits and veges?

Answer 17

64% ate three or more servings of vegetables a day
57% had 2x or more serving of fruit a day
(41% had less than recommended than both)

Question 18

Why whole grain?

Answer 18

1. Bran(husk): protects the seed (Fibres (regular and for digestion, maintains mucosal cells), B vitamins and minerals) - removed during milling/refining
2. Endosperm: energy for the seed (Carbohydrates, some protein, B vitamins)
3. Germ: nourishment for the seed (B vitamins, Vitamin E, minerals, phytochemicals)
   The bran and germ are removed when whole grains are refined
   -Cancer
   -Weight control
   -CVD
   -some people find difficult to change, culturally (e.g. asians eating white rice)

Question 19

Why Milk

Answer 19

Vitamins A+D (fat soluble vitamins)
Calcium (continually drink for bone health to maintain structure. bank Ca during adolescence in bone matrix/structure, keeps bone healthy for rest of life.)
Protein
50% of NZ adults use reduced fat/trim cows milk (staurated fat risk for CVD)
staple in NZ, easy way to get Ca2+. but many other cultures dont naturally consume milk. -can get Ca from other sources: nuts, seeds, fish bones, green leafy veges, brocolli

Question 20

Healthy vs Osteoporotic Bone

Answer 20

Healthy: internally calcified, dense bone matrix/framework

Osteoporotic:
“loss of mineral in bone structure”
-as age, lose minerals of bone, framework thinner
-if premature, more likely to fracture as without density/calcium embedded in framework
-more susceptible to getting broken bone
-high rates in postmenopausal women
-more elderly woman die/hospitalisation of osteoporosis due to falling and going to hospital > breast cancer
“silent killer” no good awareness

Question 21

Why legumes, nuts, fish, poultry, eggs, meat with fat removed?

Answer 21

nuts and meat used to be spearate. but not try consume now consume more nut/legume/fish/egg>animal proteins
-very good evidence for fish/nut/legume reducing health risk
Protein (important for cellular/muscle function)
Iron, Zinc
Vitamin A,E (fat soluble)
Fatty Acids (try consume more fish for heart healthy omega 3 fatty acids)
Cancer (bowel and hormonal)
Diabetes
CVD

Question 22

Eating Statement 2: Choose and/or prepare foods and drinks:

Answer 22

1. With unsaturated fats instead of saturated fats
2. That are low in salt(sodium); is using salt, choose iodised salt
3. with little or no added sugar
4. that are mostly “whole” and less processed

Question 23

Energy Density

Answer 23

Muesli vs Donut for breakfast
Modern society, v easy to consume little food that is high in energy. don’t need to chew much, easy into stomach and digest (1hr vs 4 hr), less vit. and nutrients(as less variety)
1. Tend to eat more processed food. which is:
2. Nutrient poor
3. Energy dense
-eat without thinks much about it
4. dont have to chew much. Dont stay full for long (so go eat again)
Consume too much energy as doesn’t take as long as is too easy, with insufficient nutrients)

Question 24

Fats

Answer 24

lower saturated fats

• eat fats from whole foods
• not from foods that have added fats (processed foods have saturated fats, or fats which have been heated to high temp to become trans-fats (act similar to saturated fats in your body))

Question 25

Prolonged high Sodium-Chloride Intake

Answer 25

"Target-organ damage due to High Intake of Sodium-Chloride)
eat 9g daily. should only have 3g
1. Increased arterial pressure (hypertension--> CDV)
2. Heart:
-Cardiac hypertrophy
-Diastolic dysfunction
-Systolic dysfunction (high s pressure)
3. Blood Vessels:
-Oxidative stress
-Endothelial dysfunction
-Fibrosis
-Decreased vascular elasticity (stiff)
4. Kidney:
-Glomerular injury
-Renal failure

Question 26

What are NZ’s doing re Salt?

Answer 26

Processed meats: 10%
Sauces: 6% (TS high sodium and sugar)
Bread: 26% (daily on a staple. Needed to keep bread fresher for longer)
Cakes, muffins, biscuits, pies and Pastries: 8% (taste + raising agent)
Breakfast Cereals: 6%
-doesn’t need to taste salty to be high in salt

Question 27

What are NZ’s doing re Sugar?

Answer 27

30% of NZ men + 17% NZ woman have soft/energy drinks more than 3x a week
-sugar tax in Mexico
-sugar increases energy density of food. Dont actually need but enjoy (behavioural aspects- hard to break habit. easy access, know we shouldnt eat, but difficult to stop)
Major sources of added sugars in NZ diets:
1. Non-alcoholic beverages (sugary/fizzy drinks, fruit juice + cordial)
2. sugars + sweets
3. baked goods e.g. cakes + biscuits

Question 28

Making good choices about what you eat and drink and being physically activa are important to achieve and keep a health body weight

Answer 28

balance dietary intake vs physical activity
need both to achieve healthy body weight
BMI used nationally
-needed for Obesity (escalated since 1960s (1977=9% men/11% woman –> 2013= 30% men 32% woman) -Large and fast increase (in a short period of time). All related to inactivity + diet
-technology
-involuntary physical activity, wring washing and wash dishes (no dishwashers)
-now have to really think about doing physical activity, as we are otherwise very sedentary
-need guidelines about how active to be- to try prevent people from being overweight/obese

Question 29

Translation of guideline into practice

Answer 29

Choose my plate(conceptualise food proportions)
-Half veges/fruit. 1/4 grains/carbs. 1/4 protein. Dairy on side
-huge change
No food pyramid (de-emphasize lots of carbs at bottom)