Nutrition: A Building Block for Chronic Disease Prevention - Is Food the Next "Medicine"
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Nutrition: A Building Block
for Chronic Disease Prevention
Is Food the Next “Medicine”
17th Annual Chronic Disease Prevention Symposium
Myrtle Beach, South Carolina
Phyllis Allen, MS, RD, LD
Bureau of Community Nutrition
Session Objectives:
• Participants will:
• Understand food and nutrition-related health trends in the
U.S. impacting chronic disease, morbidity and mortality.
• Learn recent evidence supporting the link between lifestyle
and health.
• Discuss the evidence-base supporting the role of diet in
prevent and treatment of chronic disease.
• Utilize specific strategies to counsel patients on
implementing dietary changes.
• I have no financial disclosures to report.
What Are the Challenges?
03/09/2019
The Future Is. . . Now the Present!
• The World Health Organization
estimates that by 2020, two-thirds
of all diseases will be a result of
lifestyle factors.
Chopra M, Galbraith S, Darnton-Hill I. A global response to a global problem: the
epidemic of overnutrition. Bull World Health Organ. 2002;80(12):952-958.
03/09/2019
6 in 10 4 in 10
Adults in the US Adults in the
have a chronic US have 2 or
disease more
THE LEADING CAUSES OF DEATH AND DISABILITY
and Leading Drivers of the Nation’s $3.3 Trillion in Annual Health Care Costs
THE KEY LIFESTYLE RISKS FOR CHRONIC DISEASE
Tobacco Poor Lack of Excessive
Use Nutrition Physical Activity Alcohol Use
Source: Centers for Disease Control and Prevention 03/09/2019
03/09/2019
Dietary Guidelines for Americans (DGA)
• 82% Don’t want to give up foods they like in order to
eat healthier.
• 68% Don’t eat fruits or vegetables at least twice a day.
• 62% Have no time to track their diet in order to eat
healthier.
• 60% Juggle both work & family and prefer to prepare
meals in 15 minutes.
• 36% have no leisure-time physical activity.
Sources: Academy of Nutrition and Dietetics
03/09/2019
Clinical Guidelines:
• Recommending lifestyle Changes:
• National Cholesterol Education Program
• Diabetes Prevention Program
• American Cancer Society
• American Heart Association
• American Diabetes Association
03/09/2019
What Does the Evidence
Support?
03/09/2019AICR MAJOR FINDINGS ON WEIGHT AND CANCER
Strong evidence that being overweight or obese throughout adulthood INCREASES the risk of:
mouth, pharynx and larynx cancers oesophageal cancer (adenocarcinoma)
•stomach cancer (cardia) pancreatic cancer
•gallbladder cancer liver cancer
•colorectal cancer breast cancer (post-menopausal)
•ovarian cancer endometrial cancer
•prostate cancer (advanced) kidney cancer
Greater weight gain in adulthood INCREASES the risk of
•postmenopausal breast cancer
Being overweight or obese as an adult before menopause DECREASES the risk of
•premenopausal breast cancer
Being overweight or obese between the ages of about 18 and 30 years DECREASES the risk of
•pre- and post-menopausal breast cancer
03/09/2019DASH DIET
Dietary Approaches to Stop Hypertension
03/09/2019DASH 20 Years Later 3
• Strong evidence • Factors Poor Adherence
• Adherence to DASH • Food environment/barriers
• NHANES 1988 – 2004 • Energy-dense, nutrient-
•DASH Diet & Hypertension Nutrition Action HealthLetter February 5, 2018 03/09/2019
03/09/2019
03/09/2019
Vegetarian and Vegan
Diets
03/09/2019Vegetarian Diets
• Mounting Evidence
• Eating more plant protein, less animal-derived protein associated
with a lower risk of coronary heart disease
• Eating more plant protein, less animal-derived protein associated
with less plaque in the arteries
• Vegetarian diet associated with reduced risk factors for heart
disease and diabetes
• Eating higher quality plant-based foods associated with lower
risk of death
• Whole grains, fruits, vegetables and nuts
compared to unhealthful plant-based foods
such as sweets, refined grains and fries
03/09/2019Vegan Diets - Many Studies
• Several studies - vegan diets
• More fiber, antioxidants & beneficial plant compounds.
• Richer in potassium, magnesium, folate and vitamins A, C and E
• Poorly planned vegan diets may provide insufficient amounts of essential fatty acids, vitamin B12, iron,
calcium, iodine or zinc
• Weight Loss
• Observation studies - thinner & lower BMIs than non-vegans
• Several randomized controlled studies more effective for weight loss
• Low-fat, low-glycemic index diet vegetarian
• Pesco-vegetarian
• Semi-vegetarian
• Omnivorous
• Participants on the vegan diet lost more weight than those who followed calorie-
restricted diets, even when the vegan groups were allowed to eat until they felt full
• Low-fat, vegan diet in pts with NIDDM –
• Significant reductions in fasting serum glucose concentration and BW in the absence of recommendations for
exercise
• Vegans tend to have lower blood sugar levels, higher insulin sensitivity and up to a 50–
78% lower risk of developing type 2 diabetes
03/09/2019Other Finding:
• Lower blood sugar level, reduce
medications & may reduce risk of
poor kidney function (reduce meat
intake)
• May protect against certain cancers
• May reduce pain from arthritis
• 2 other studies investigated the effects of a probiotic-rich, raw food vegan
diet on symptoms of rheumatoid arthritis.
• Both reported participants in the vegan group vs omnivorous diet
• Greater improvement in symptoms such as pain, joint swelling and
morning stiffness
03/09/2019Mediterranean Diet
03/09/2019• “…in terms of evidence-based medicine,
the full adoption of a modern version of
the Mediterranean diet pattern can be
considered one of the most effective
approaches for the prevention of fatal
and nonfatal CVD complications.”
deLorgeril, et. al. Current Atherosclerosis Reports. 2013;15(12):1-5.
03/09/2019Research on the Mediterranean Diet Romagnolo D. F., Selmin O. I. Mediterranean diet and prevention of chronic diseases. Nutrition Today. 2017;52(5):208–222. doi: 10.1097/NT.0000000000000228 03/09/2019
Mediterranean Diet
• PREDIMED
• Primary Prevention of CVD Mediterranean Diet Supplemented with Extra-
Virgin Olive Oil (EVOO) or Nuts
• N = 7447 55-80 years, 57% women
• High CVD risk, No CVD cardiovascular disease @ enrollment
• Med Diet supplemented with EVOO, Med Diet supplemented with mixed nuts,
or control diet w advice to reduce dietary fat
• MI, stroke, or death from cardiovascular causes
• 4.8 yrs follow-up
• Major cardiovascular events lower assigned to a Med Diet
supplemented with EVOO oil or nuts than those assigned to a
reduced-fat diet
• Incidence of CVD w Mediterranean diet groups was lowered by
approximately 30% when compared to the control diet
Estruch, R., et.al., N Engl J Med 2018: 378:e34
03/09/2019Benefits of Med Diet
• Can reduce the risk of CVD • 40% lower risk of developing
by 30 - 60% Alzheimer’s
• Decreases the risk of some • May improve eye health
forms of cancers including decreasing risk of
macular degeneration
• More effective than LF diet
for weight loss in OW & OB • Reduce risk of type 2
diabetes,
• Protect against cognitive • One study – type 2 diabetes
decline by protecting small reduced by 52% following
blood vessels in brain Mediterranean diet
• Can help manage blood
pressure
03/09/2019Characteristics of the MED Diet • vegetables, fruits, grains, legumes, nuts, & fish • red meat & whole-fat dairy • Moderate red wine • Liberal use of olive oil in cooking & food prep • Rich in fiber, omega-3 fatty acids, antioxidants, polyphenols • Low in saturated fat & refined CHO
DASH Mediterranean
Combination Plan
03/09/2019Brain Health
03/09/2019Statistics:
• Everyone knows someone with dementia or
Alzheimer’s disease
• Over 5 million Americans with the disease
• 1 in 9 adults 65 and older
• Expected to triple by 2050
• WHY?
• Living longer
• Advancing age is the #1 risk factor
• Aging in not the sole risk factorUS Department of Health & Human Services April 2015
03/09/2019Heart-Head Connection
03/09/2019Fig. 2. Strength of evidence on risk factors for dementia.
M. Baumgart et al. / Alzheimer’s & Dementia 11 (2015) 718-726MIND Diet
Dementia & Alzheimer’s Disease
03/09/2019Diet & Dementia
• Vitamin E
• Omega-3 Fatty Acids
• The strongest evidence for
antioxidant protection
against AD rests with high
dietary intake of vitamin E.
• Dietary Fats & AD
• Saturated fat associated with a doubling
in the risk
• Trans-fats associated with two to three
times the risk
• Highest quintile of n-6 polyunsaturated
fat intake had 70% lower risk of AD
• Monounsaturated fat 80% reduction in
risk amongst persons in the fourth and
fifth quintiles of monounsaturated fat
intake.
• Suggest elevated cholesterol in midlife –
independent risk for AD
• More study needed type of dietary fat
& risk of AD
03/09/2019Phase I Study – Risk of AD
• MIND Diet
• 15 points for components of diet
• Top third 9.6 average score ( 8.5 to 12.5)
• Middle third 7.5 average score (7 to 8 points)
• Top 1/3 cut risk 53%; Middle 1/3 cut risk 35%
• Mediterranean Diet
• Top 1/3 cut risk by 54%
• DASH Diet
• Top 1/3 cut risk by 39%
03/09/2019MIND Diet
• 15 Components: • Diet Principles
• 10 “brain healthy foods” • Daily
• Green leafy vegetables, • 3 or more whole grains
other vegetables, nuts, • Salad + another
berries, beans, whole vegetables
grains, fish, poultry, olive
• Glass of red wine
oil, wine
• Snacking – primary nuts
• 5 “brain unhealthy foods”
• Beans – every other day
• Red meats, butter and
stick margarine, whole fat • Poultry & Berries – twice a
cheese, pastries and week, especially blueberries
sweets, fried and fast • Fish – at least once a week
foods
03/09/2019Summary:
• Diet – role in Prevention
• Protect for inflammation & oxidation
• Antioxidants
• vitamins E & C, flavonoids, plant compounds,
healthy fats
• No evidence treat or reverse with diet
• Never to early to consume healthy foods
good for the brain.
03/09/2019Nutrition & Inflammation
• Obesity – Increased risk of CVD, DM, Hypertension,
Metabolic Syndrome, Non-alcoholic fatty liver &
some cancers
• Metabolic Syndrome
• Type 2 Diabetes
• Atherosclerosis
• Cancer
• Rheumatoid Arthritis
03/09/2019• Pro-inflammatory Nutrients: • Anti-Inflammatory Nutrients:
• Excess calories • Omega-3 polyunsaturated
fatty acids
• Excess carbohydrates
• Ascorbic acid
• Refined carbohydrates
• Vitamin E
• Trans fatty acids • Polyphenols
• Saturated fatty acids • Compounds found in
fruits, vegetables, grains,
• Omega-6 polyunsaturated chocolate, coffee, olive oil,
tea
• Probiotics & prebiotics
03/09/2019Vitamin K & Osteoarthritis
• Essential role blood clotting • Clinical trials needed
• Tuft’s & Boston Universities • Supplements Vit K & D above
recent studies on vitamin K daily amounts NOT
potential role – joint cartilage recommended for people w
health arthritis
• Adequate vitamin K –slow
progression of osteoarthritis • Change seen when low in
vitamins K & D
• ? Prevent calcification of the
joints (vitamins K & D) • Recommendations:
• NIH funded research • Consume adequate Vit K & D
from diet
• Adults 60 – 75
• Eat leafy greens vegetables
• Adequate vitamins D & K
• Walk usual distances faster
& rise from chair or sit back
down more easily
03/09/201910 Ways Foods Can Reduce Inflammation
• Boost fruits & • Replace white potatoes
vegetables with sweet potatoes
• Cook with olive oil • Cut down on sugary
• Walnuts drinks
• Eat whole grains • Eat more lentils and
beans
• Eat fatty fish
• Dark chocolate &
• Eat fewer fast foods raspberries
Franz, M. Today’s Dietitian Feb 2014:Vol. 16 No.2 P. 44 03/09/2019TOTAL DIET APPROACH
• The foundation • Factors Influences Eating Practices:
of a healthy • Taste & Preferences
lifestyles includes • Weight concerns
physical activity • Physiology
• Time & convenience
and consuming a
• Environmental
balanced variety • Home, school, workplace
of a nutrient-rich • Demographics factors
foods and • Age, SES, Ethnicity
beverages in • Media & marketing
moderation. • Culture
• Heritage, religion, body image
Sources: Academy of Nutrition and Dietetics 03/09/2019Strategies for the Individual:
Pulling It All Together
03/09/2019Figure 1 Journal of Nutrition Education and Behavior 2014 46, 90-101 DOI: (10.1016/j.jneb.2013.09.005 03/09/2019
Eight Healthy Eating Goals & Specifics(HHS)
• Make half your plate fruits and
• Follow a healthy eating vegetables
pattern across the lifespan.
• Make half the grains you eat
• Focus on variety, nutrient whole grains
density, and amount. • Switch to fat-free or low-fat (1%)
milk
• Limit calories from added
sugars and saturated fats • Choose a variety of lean protein
foods
and reduce sodium intake.
• Compare sodium in foods
• Drink water instead of sugary
drinks
• Eat some seafood
• Cut back on solid fats
03/09/2019Find your healthy eating style and maintain it for a lifetime.
• MyPlate is a • Everything you eat and drink
matters. The right mix can
reminder for help you be healthier now
consumers to find and into the future.
their healthy eating • Focus on variety, amount,
style and build it and nutrition.
throughout their • Choose foods and beverages
with less saturated fat,
lifetime. sodium, and added sugars.
• Start with small changes to
build healthier eating styles.
• Support healthy eating for
everyone.
03/09/2019Making It Work
• Stages of Change • Access
• Good fit • Information &
• Work for education
individual/family
• Financial constraints
• Significant change
• Simple steps
03/09/2019Questions?
Thank You
Phyllis Allen allenpa@dhec.sc.gov 803-898-0809 (w)
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