Nutrition Science, Assessment And Prescription Guidelines Flashcards
What is an underconsumed nutrient/food (2020 Dietary Guidelines Advisory Committee Report)?
Underconsumed by >=5% of popn relative to EAR (est avg requirement), AI (adequate intake) etc
Replaces term shortfall nutrient
What is an overconsumed nutrient/food (2020 Dietary Guidelines Advisory Committee Report)?
Consumed in potential excess of UL (tolerable upper limit level), CDRR (chronic disease risk reduction level) by >= 5% of popn or in specific groups from diet alone
What are the overconsumed nutrients in the US?
Added sugars
Saturated fat
Sodium
Current intake of added sugar among US adults and children > 6 yrs is 14.1% of total calories
SSBs contribute more sugar calories than any other single food or beverage
What are the WHO recommendations for daily sugar consumption?
Both adults and children to limit their daily consumption of added sugar to:
LESS THAN 10% TOTAL CALORIES (12 teaspoons/48g)
Goal amount less than 5% (6 teaspoons/24g)
What are the AHA recommendations for daily sugar consumption?
Women, children and teens:
Max 100kcal (6 teaspoons/24g)
Men:
Max 150kcal (9 teaspoons/36g)
What are the AHA recommendations for saturated fat intake?
No more than 5-6% of total calories
What are the top 5 sources of percent saturated fat in the diets of US adults?
- Cheese (16.5%)
- Beef (9.1%)
- Other fats and oils (8.9%)
- Milk (6.7%)
- Frankfurters, sausages and luncheon meats (6.7%)
Which foods groups are highest in salt?
Commercially prepared foods
Around 50% of dietary salt intake comes from mixed dishes (burgers, sandwiches, tacos, rice, pasta, pizza, meat, poultry, seafood dishes and soups)
Top sources sodium:
1. Added to food outside of home (70.9%)
2. Inherent to food (14.2%)
3. Added in home food preparation (5.6%)
4. Added at the table (4.9%)
What is the recommended daily limit of salt intake?
2020-2025 Dietary Guidelines for America:
Adults should consume no more than 2300mg
Jeff Novick rule:
If sodium per serving is less than or equal to the kcal per serving someone eating 2300kcal total per day will keep salt intake at approximately 2300mg per day or less
What is the daily recommended amount of fibre in the diet?
FDA states daily value of 28g per day based on 2000 kcal diet
Harvard School of Public Health recommend maximum 10-1 carbohydrate-fibre ratio
What are the recommendations on cholesterol consumption?
2020-2025 Dietary Guidelines for Americans:
Limit cholesterol consumption as much as possible without compromising nutritional adequacy
What are the top sources of cholesterol in the US diet?
Cholesterol is found exclusively in animal foods
- Meat (42%)
- Eggs (25%)
- Grain products (17%)
- Milk and milk products (11%)
What are the sources of Trans fats in the diet?
Mostly found in partially hydrogenated plant oils
Also occur in meat and dairy products
Can be avoided by reducing/eliminating:
1. Animal foods, esp red and processed meats
2. Butter (approx 10% of total fat in butter is trans fat)
3. Refined grain products (doughnuts, cookies, crackers, muffins, pies and cakes)
What are the nutrients underconsumed by the entire population?
- Calcium
- Choline
- Fibre
- Magnesium
- Potassium
- Vitamin A
- Vitamin C
- Vitamin D
- Vitamin E
- Vitamin K
What are the nutrients of public health concern?
Calcium
Fibre
Potassium
Vitamin D
Can Feel Potentially Dangerous
Grade 1 carcinogens:
Alcohol
Processed meats
Which type of diet can meet or exceeed nutrient recommendations for nutrients of public health concern for adult men and women?
Except for vitamin D and B12 a whole-food plant-based diet with no animal products or highly processed foods
Which supplements may be necessary to maintain nutrient intake?
Vitamin D - especially in latitudes with less sun exposed
Vitamin B12 - advised for all older adults and those consuming WFPB diet
What are nutrient dense foods (most underconsumed nutrients with the least overconsumed nutrients per kcal)?
- Vegetables, including mushrooms
- Herbs and spices (eaten in small quantities(
- Fruits
- Legumes
- Whole grains
- Nuts
- Seeds
What are common unregulated front-of-package claims?
Natural
Lightly sweetened
Slightly sweet
Less sweet
FDA has prohibited food makers from marketing products as ‘Low Sugar’
FDA considering defining how ‘Natural’ can be used on food labels
What are common regulated front-of-package claims?
Good Source
- One serving contains 10-19% DV of a certain nutrient
Excellent Source
- One serving contains >= 20% DV of a certain nutrient
Gluten-free
- Fewer than 20 parts per million of gluten
Certified Organic
- Produced without pesticides, herbicides, synthetic fertilisers, sewage sludge, bioengineering, ionising radiation and is not a genetically modified organism (GMO)
(Rule of thumb when looking at %DV:
5% DV or less of a nutrient per serving is considered low
20% DV or more of a nutrient per serving is considered high)
What were the primary aims of ACLM meta-epidemiological study in 2021-22 of clinical practice guidelines that included dietary guidance?
Compare recommendations for:
Overall dietary patterns
Major food groups
Food components frequently address in research and clinical settings such as salt, saturated fat, protein, sugar etc
What were the included studies of ACLM meta-epidemiological study in 2021-22 of clinical practice guidelines that included dietary guidance?
78 clinical practice guidelines published between 2010-2021 that address nutrition for a variety of health conditions as well as general health promotion
83% > major medical professional societies
12% > governments
5% > large health stakeholder associations
What were the results of ACLM meta-epidemiological study in 2021-22 of clinical practice guidelines that included dietary guidance?
83% guidelines made food group recommendations
- include/increase (encourage intake)
- exclude/decrease/limit
15 food groups were analysed
Most frequently encouraged intake of:
1. Vegetables (74%)
2. Fruit (69%)
3. Whole grains (58%)
Also encouraged:
4. Legumes/pulses (47%)
5. Any nuts/seeds (44%)
6. Low-fat dairy (38%)
7. Any fish/seafood (36%)
Most frequently discouraged intake of:
1. Red meat (32%)
2. Processed meat (27%)
3. Refined grains (19%)
4. Fatty meat (12%)
None of reviewed guidelines explicitly recommended include/increase intake of fatty meat, red meat, full-fat dairy, refined grains or salted nuts
What is ACLM’s dietary position statement?
For the treatment, reversal, and prevention of lifestyle-related chronic disease, the ACLM recommends eating a plant-predominant diet based on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts and seeds
What are the US Dietary Guidelines for Americans 2020-2025?
Intended for a health professional audience and to guide nutrition advice given to pts and consumers
Jointly issued by US Department of Agriculture (USDA) and US Department of Health and Human Services (HHS)
Updated every 5 years
Based on recommendations from the Dietary Guidelines Advisory Committee (DGAC) which is composed of nutrition and medical researchers
After experts create DGAC scientific report the secretaries of USDA and HHS take public comments and consider both evidence and public comment in crafting final DGA
Allows food industry + special interests to influence public policy > discrepancies between recommendations and scientific evidence
2017 National Academies of Sciences, Engineering and Medicine released a report calling for overhaul of DGA process to eliminate bias
What are Canada’s Dietary Guidelines?
Published by Health Canada
Key message: Nutritious foods are the foundation for healthy eating
Vegetables, fruit, whole-grains and protein foods should be consumed regularly
Among protein foods consume plant-based more often
While many animal-based foods are nutritious Guideline 1 emphasises more plant-based foods. The regular intake of plant-based foods: vegetables, fruit, whole-grains, and plant based proteins can have positive effects on health
Foods that contain mostly unsaturated fat should replace foods that contain mostly saturated fat
Water should be the beverage of choice
What does the Global Burden of Disease Report show in regards to dietary risk factors and attributable mortality?
Descending order:
- Diet high in sodium
- Diet low in whole-grains
- Diet low in fruits
- Diet low in nuts and seeds
- Diet low in vegetables
- Diet low in seafood omega-3 fatty acids
- Diet low in fibre
- Diet low in polyunsaturated fatty acids
- Diet low in legumes
- Diet high in trans fats
- Diet low in calcium
- Diet high in SSBs
- Diet high in processed meats
- Diet low in milk
- Diet high in red meat
Poor diet is responsible for more deaths globally than tobacco, high blood pressure or any other disease risk
Dietary habits account for every 1 in 5 deaths globally
What are Western-Style Diets?
- Low in whole plant foods
- High in red and processed meat, fat, sodium, processed foods, added sugar and calories
70% sodium intake > bought foods + restaurants
Added sugars > extra 266kcal/day in US
UPFs ~ 60% of energy intake
Contribute to overall increase in chronic disease risk
Considered major contributor to US obesity epidemic
Abundant in nutrient poor UPFs
- >4 servings a day assoc with 62% increased risk of death from any cause
- each additional daily serving leads to 18% increased risk of death
- higher intake assoc with long-term weight gain
- large cohort studies show direct assoc with high all-cause mortality
What are the key health benefits of the Mediterranean diet?
High monounsaturated-to-saturated fat ratio; high fruit, vegetables, legumes, grain and cereal intake
Moderate red wine and dairy intake
Low consumption of meat and meat products with increased intake of fish
May contribute to CVS health
- improvements in BP, serum triglycerides and cholesterol
- limited evidence to support reduced incidence of CVS events or breast cancer
- high vs low adherence:
- 41% lower risk of CVD mortality
- 27% lower risk of CVD incidence
What are the key health benefits of the Dietary Approach to Stop Hypertension (DASH) diet?
Low in saturated, trans fats and sodium (1500-2300mg/day sodium)
Rich in potassium, calcium, magnesium, fibre and protein
Emphasises vegetables, fruits and whole grains
Include fat-free or low fat dairy products, fish, poultry, beans, nuts and vegetable oils
Limit foods high in saturated fat
Limit SSB and sweets
Associated with lower incidence of CVD and outcomes (CHD, stroke, HF)
May help with weight management
Decreases LDL cholesterol, BP and other cardio metabolic risk factors, diabetes and CVS mortality
