Transcript Eating Healthy: Tips for Families & Communities

Eating Healthy: Tips for
Families & Communities
Darlene E. Berryman, PhD, RD, LD
School of Human and Consumer Sciences,
OU
Outline
• 2010 ADA Clinical Practice
Recommendations
– Glycemic load vs. index
– Trans Fat
– Fiber
• Nutrition in the Appalachian Region
– Current state
– Economics of nutrition
• Recommendations for Families and
Communities
• 2011 Health Summit
Clinical Practice Recommendations
• Nutrition-Related
Recommendations
• Level of Evidence Ratings
http://care.diabetesjournals.o
rg/content/33/Supplement_1/
S11.full
– A = Clear evidence from wellconducted studies, generalizable
studies
– B = supportive evidence from wellconducted, non-generalizable studies
– C = Supportive evidence from poorly
controlled studies
– E = Expert consensus or clinical
experience
General Recommendations
• Individuals who have pre-diabetes or
diabetes should receive individualized MNT
as needed to achieve treatment goals,
preferably provided by a registered dietitian
familiar with the components of diabetes
MNT. (A)
• Because it can result in cost savings and
improved outcomes (B), MNT should be
covered by insurance and other payors (E).
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Energy balance, overweight,
and obesity
• In overweight and obese individuals,
modest weight loss has been shown to
reduce insulin resistance. Thus, weight loss
is recommended for all overweight or obese
individuals who have or are at risk for
diabetes. (A)
• For weight loss, either low-carbohydrate or
low-fat calorie-restricted diets may be
effective in the short-term (up to 1 year). (A)
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Energy balance, overweight,
and obesity
• For patients on low-carbohydrate diets,
monitor lipid profiles, renal function, and
protein intake (nephropathy) and adjust
hypoglycemic therapy as needed. (E)
• Physical activity and behavior modification
are important components of weight loss
programs and are most helpful in
maintenance of weight loss. (B)
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Carbohydrate Intake
• Monitoring carbohydrate intake,whether by
carbohydrate counting, exchanges, or
experience-based estimation, remains a key
strategy in achieving glycemic control. (A)
• For individuals with diabetes, use of the
glycemic index and glycemic load may
provide a modest additional benefit for
glycemic control over that observed when
total carbohydrate is considered alone. (B)
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Fat Intake
• Saturated fat intake should be <7% of total
calories. (A)
• Reducing intake of trans fat lowers LDL
cholesterol and increases HDL cholesterol
(A); therefore, intake of trans fat should be
minimized (E).
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Primary Prevention
• Recommended for individuals at high risk for
developing type 2 diabetes:
– structured programs emphasizing lifestyle
changes that include moderate weight loss (7%
body weight) and regular physical activity (150
min/week) with dietary strategies including
reduced calories and reduced intake of dietary
fat. (A)
– achieve the USDA recommendation for dietary
fiber (14 g fiber/1,000 kcal) and foods containing
whole grains. (B)
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Other nutrition recommendations
• Sugar alcohols and nonnutritive sweeteners
are safe when consumed within the
acceptable daily intake levels established by
the FDA. (A)
• Routine supplementation with antioxidants,
such as vitamins E and C and carotene, is
not advised because of lack of evidence of
efficacy and concern related to long-term
safety. (A)
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Other nutrition recommendations
• Benefit from chromium supplementation in people
with diabetes or obesity has not been conclusively
demonstrated and therefore cannot be
recommended. (C)
• If adults with diabetes choose to use alcohol, daily
intake should be limited to a moderate amount (1
drink per day or less for adult women and 2 drinks
per day or less for adult men). (E)
• Individualized meal planning should include
optimization of food choices to meet recommended
dietary allowances (RDAs)/dietary reference intakes
(DRIs) for all micronutrients. (E)
American Diabetes Association. Standards of medical care in
diabetes—2010. Diabetes Care 2010;33(Suppl. 1):S11–S61
Outline
• 2010 ADA Clinical Practice
Recommendations
– Glycemic load vs. index
– Trans Fat
– Fiber
• Nutrition in the Appalachian Region
– Current state
– Economics of nutrition
• Recommendations for Families and
Communities
• 2011 Health Summit
Glycemic Index vs Glycemic Load
• Glycemic index (GI) - Increase in
blood glucose during 2-hour period after
consumption of a certain amount of CHO
compared with equal CHO from reference
food
• Factors that influence GI:
–
–
–
–
–
–
–
Processing
Type of starch
Fiber content
Ripeness of fruit
Fat or acid content
Preparation
Other factors
Glycemic Index vs Glycemic Load
• Glycemic Load
• GI compares foods containing the same amount of CHO
• However, the amount of carbohydrate consumed also
affects blood glucose levels and insulin responses
• GI x g of CHO in 1 serving of food
Glycemic Index vs Glycemic Load
Food
Glycemic Index
Glycemic Load
CHO Calculation
Instant Rice
91
28
2/3 cup = 31g
Baked Potato
85
20
~1 cup = 23g
Cornflakes
84
19
~1 cup = 23g
Carrot
71
4
½ cup = 6g
White Bread
70
18
2 slices = 25g
Rye Bread
65
16
2 slices = 25g
Muesli
56
24
½ cup = 42g
Banana
53
21
1 large = 40g
Spaghetti
41
13
1 cup = 32g
Apple
36
9
1 large = 26g
Lentil Beans
29
6
½ cup = 19g
Milk
27
3
1 cup = 11g
International table of glycemic index and glycemic load values American Journal of Clinical Nutrition, 76:
5-56, 2002
Trans Fat
• What are they?
– adding hydrogen to
liquid oils to make
them more solid in
a process called
hydrogenation
• Why?
– 60s-70s - saturated
fat replacement
– Inexpensive
– Do not spoil easily
– Spreadable
Trans Fat
• Recommended amount: “as
low as possible”
• Part of food label since 2006
• Additional facts:
– Average consumption 5–8g of trans
fat/day, or 45–72 calories, or 2-3% of
total calories/day
– ~80% of US adults had no idea which
foods contain trans fat
– Easy to get too much even if
consuming “0g” on food label…how?
– Significant decrease in consumption
since 2005
Trans fat
http://www.nyc.gov/html/doh/html/pr/
pr083-05.shtml
Fiber
Dietary Fiber
• “Non-digestible
carbohydrates and
lignin that are
intrinsic and intact in
plants”
• Contain other
nutrients
• Mixture of fibers
Functional Fiber
• “fibers added to foods
during processing”
• No other nutrients
• Single fiber
Total Fiber = Dietary Fiber + Functional fiber
Fiber
Fiber
http://www.cnpp.usda.gov/
Publications/FoodSupply/Fi
berFactSheet.pdf
Fiber
• DRV 25g/day
• 5 grams or higher defined as high fiber
• Look for the word “WHOLE” when choosing
whole grain products
• Specific health claims
Fiber
Common themes
Healthier
Diet
Less
Processed
Plant based
= lower glycemic index, lower trans fat, higher fiber
Outline
• 2010 ADA Clinical Practice
Recommendations
– Glycemic load vs. index
– Trans Fat
– Fiber
• Nutrition in the Appalachian Region
– Current state
– Economics of nutrition
• Recommendations for Families and
Communities
• 2011 Health Summit
Current Status
• Higher obesity prevalence in adults and children
(ARC, 2008; Tulkki 2006; Demerath 2003).
• Food insecurity rates higher in Appalachian
Ohio; three times higher than the rest of the
state, double the rate of the nation (Holben et al., 2004;
Holben & Pheley, 2006; Kropf et al., 2007; Meek, 2005; Walker et al., 2007).
• Obesity rates greater in food-insecure
households in Appalachian Ohio (Holben & Pheley, 2006;
Holben & Pheley, 2006; Pheley et al., 2002).
• ¼ of the grocery stores in rural areas support
healthy eating guidelines by providing
recommended foods while most offered only
cheaper convenience foods (Liese et al, 2007).
2000 Poverty Rate
•
•
•
•
US = 12.4%
Appalachia = 13.0%
Ohio = 10.6%
Athens Co = 27.4%
Economics of Food
Economics of by Food Group
FIGURE 2 Median Nutrient Rich Foods (NRF9.3) Index scores for each major US Department of
Agriculture food group plotted against median cost per 100 kcal
Drewnowski, A. Am J Clin Nutr 2010;91:1095S-1101S
Copyright ©2010 The American Society for Nutrition
Arch Intern Med. 2010;170(5):420-426
SES and food intakes
Am J Clin Nutr 2008; 87:1107–17.
What can a community do?
• Recommended Community
Strategies and Measurements to
Prevent Obesity in the United
States, CDC Report, 2009
http://www.cdc.gov/m
mwr/pdf/rr/rr5807.
pdf
• “a comprehensive and coordinated
approach that uses policy and
environmental change to transform
communities into places that support and
promote healthy lifestyle choices for all
U.S. residents.”
• “Describes the expert panel process
used to identify 24 recommended
strategies for obesity prevention and a
suggested measurement for each
strategy that communities can use to
assess performance and track progress”
General Categories of
Recommended Strategies
• Strategies to Promote the Availability of Affordable
Healthy Food and Beverages (6)
• Strategies to Support Healthy Food and Beverage
Choices (4)
• Strategy to Encourage Breastfeeding (1)
• Strategies to Encourage Physical Activity or Limit
Sedentary Activity Among Children and Youth (4)
• Strategies to Create Safe Communities That
Support Physical Activity (8)
• Strategy to Encourage Communities to Organize for
Change (1)
Strategy 3
• Communities Should Improve Geographic
Availability of Supermarkets in
Underserved Areas
• Supermarkets and full-service grocery stores have a larger
selection of healthy food (e.g., fruits and vegetables) at lower
prices compared with smaller grocery stores and convenience
stores.
• Research suggests that low-income, minority, and rural
communities have fewer supermarkets as compared with more
affluent areas.
• Suggested Measurement: The number of full-service grocery
stores and supermarkets per 10,000 residents located within
the three largest underserved census tracts within a local
jurisdiction.
Strategy 6
• Communities Should Provide Incentives
for the Production, Distribution, and
Procurement of Foods from Local Farms
• Currently, US is not producing enough fruits, vegetables, whole
grains, and dairy products for all citizens to eat the quantities of
these foods recommended
• Suggested measurements - Local government has a policy that
encourages the production, distribution, or procurement of food
from local farms in the local jurisdiction.
• This measurement captures local policies, as well as state- and
federal-level policies that apply to a local jurisdiction and aim to
encourage the production, distribution, and procurement of
food from local farms.
What can
Families/Communities Do?
• “Small Change Approach”
• Am J Clin Nutr. 2009 Feb;89(2):477-84.
Epub 2008 Dec 16.
• Examples:
– US Department of HHS launched a smallchanges initiative that included television and
radio commercials and a website
(www.smallstep.gov).
– Message was promoted by the US Surgeon
General
(www.surgeongeneral.gov/priorities/prevention).
Health Summit 2011
Coming soon near you!
[email protected]