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Adrianne Bendich - Nutrition and Health: Preventive Nutrition

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Adrianne Bendich Nutrition and Health: Preventive Nutrition

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Part I
Global Issues
Springer International Publishing Switzerland 2015
Adrianne Bendich and Richard J. Deckelbaum (eds.) Preventive Nutrition Nutrition and Health 10.1007/978-3-319-22431-2_1
1. Preventive Nutrition: From Public to Personal Recommendations and Approaches to Behavior Change
Sara C. Folta 1, Alison G. M. Brown 1 and Jeffrey B. Blumberg 1, 2
(1)
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
(2)
Jean Mayer USDA Human Nutrition Research Center on Aging, Friedman School of Nutrition Science and Policy, Tufts University, 711 Washington Street, Boston, MA 02111-1524, USA
Jeffrey B. Blumberg
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Keywords
Behavior change Community-level change Dietary acculturation Dietary guidance Dietary supplementation Fat tax Food desert Food security Food swamp Health belief model Motivational interviewing MyPlate Nutrition security Preventive nutrition Personalized nutrition Soda tax Smartphones Social Cognitive Theory Socioecological Model Sustainability Theory of Reasoned Action and Planned Behavior Transtheoretical Model Upstream doctors
Key Points
  • National dietary guidelines for general audiences are increasingly focused on a holistic view of nutrition with an emphasis on whole foods and dietary patterns in the context of long-term environmental sustainability.
  • Personally tailored nutrition guidance is emerging via assessment of genetic and biochemical profiles directed to individualized dietary recommendations for health promotion and disease prevention.
  • The Socioecological Model, Health Belief Model, Theory of Reasoned Action and Planned Behavior, Transtheoretical Model, and Social Cognitive Theory are frameworks that help to explain and predict dietary behavior at the individual level.
  • Motivational interviewing is an effective behavioral strategy at the individual level within a health care setting for promoting dietary behavior change.
  • Smartphone applications may be useful tools to promote dietary behavior change and assist with self-monitoring of dietary behaviors.
  • Culture strongly influences dietary preferences and health beliefs also influence dietary behaviors.
  • Health care professionals can play broad but nontraditional roles in support of their patients by addressing the upstream root causes of diseases and conditions related to diet.
  • Policies at global, national, and local levels can shape dietary behaviors by influencing food availability and price, dietary guidelines, nutrition information, nutrition standards, and support for nutrition programs.
Introduction
The first International Conference on Nutrition in 1992 and subsequent World Food Summits and related action plans organized by the Food and Agriculture Organization of the United Nations and the World Health Organization have repeatedly reaffirmed their commitment of the right of everyone to have access to safe, sufficient, and nutritious food. In 2014, the Second International Conference on Nutrition acknowledged that malnutrition including undernutrition, micronutrient deficiencies, overweight, and obesityis widespread and not only affects health and well-being of people but also restricts the attainment of human potential and pose a high burden of adverse social and economic consequences to individuals, families, communities, and nations []. Implementing practices and policies that promote health at both public and personal levels requires new ways of utilizing the reductionist and holistic paradigms of preventive nutrition and approaches that help support behavioral changes within communities and in individuals.
Preventive Nutrition and Public Health
About 80 % of all chronic disease and associated premature death around the globe is likely preventable with the uncontroversial knowledge we now possess. Among adults who do not smoke and avoid excessive consumption of alcohol, diet influences long-term health prospects more than any other environmental factor. Over the last 30 years, the more affluent countries have made substantial progress in improving life expectancy at birth and overall healthy life expectancy (i.e., the number of years that a person at a given age can expect to live in good health, taking into account mortality and disability). However, the prevalence of morbidity and chronic disability now accounts for about half of the health burden in these countries. In the USA, about half of all adults have one or more preventable chronic diseases directly related to poor quality dietary patterns and physical inactivity, including cardiovascular disease, hypertension, type 2 diabetes, and diet-related cancers. More than two-thirds of adults and nearly one-third of children and adolescents are overweight or obese.
Although the USA spends the most per capita on health care across all countries, it lags behind other high-income countries for life expectancy and other health outcomes []. Nonetheless, most health care systems continue to be focused on disease treatment rather than prevention.
Dietary Guidelines: A Holistic Approach
Dietary guidelines for general audiences are a public policy of preventive nutrition and have been increasingly focused more on a holistic view of nutrition with an emphasis on whole foods and dietary patterns rather than on specific macronutrients and micronutrients. This is a sound approach as the evidence for diethealth relationships is more consistent for dietary patterns than for single foods or ingredients. In part, this is because a broader, holistic perspective of preventive nutrition includes the interactions between foods and food components where synergistic interactions appear to occur []. Nonetheless, challenges exist in summarizing these data due to the varying definitions of food groupings found in the literature. For example, total meat has been defined as a variety of different combinations of categories including meat (red, processed, or other), sausage, poultry, fish, and eggs. The definition of vegetables does not distinguish between categories and also often excludes potatoes but when included, information is rarely provided about their preparation, e.g., baked, boiled, or fried.
Despite such limitations, there is a broad consensus that healthy dietary patterns are higher in fruits and vegetables, whole grains, seafood, legumes, and nuts and lower in sugar-sweetened foods and beverages, refined grains, red and processed meat []. Following guidelines for a healthful dietary pattern appear associated not only with a reduced risk of prevalent disorders like cardiovascular disease and obesity but also can have benefits across a broad array of chronic conditions and can thus be promoted to entire populations. It is important also to recognize that these dietary patterns can be achieved in a variety of ways but need to be tailored to sociocultural preferences so as to be more likely to be adopted by diverse population groups.
This holistic approach to improve nutritional recommendations by considering broad dietary patterns is considered a holistic or top-down approach that presumes the complex relations underlying diethealth relationships cannot be modeled on the basis of a linear causeeffect relation between a single nutrient and its physiologic or metabolic effect []. However, historically, nutritional recommendations have been developed from reductionist or bottom-up approaches from specific considerations of foods as a source of critical ingredients, e.g., dairy for calcium and citrus fruits for vitamin C.
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