Achieving Wellness Dietary Guidelines: From Pyramids to...
Transcript of Achieving Wellness Dietary Guidelines: From Pyramids to...
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UCSF Osher Mini Medical School
Dietary Guidelines: From Pyramids to Plates
Katie Ferraro,MPH, RD, CDE
Achieving Wellness
Proper Diet
Proper Diet
Positive LifestylePositive Lifestyle
WellnessWellness
Poor DietPoor Diet
Negative LifestyleNegative Lifestyle
Death & DiseaseDeath & Disease
Did You Know?
o 65% of the world’s population live in countries where overweight and obesity kill more people than underweight
o More people are overweight than underweight in the world
World Health Organization, Media Centre, Obesity and Overweight, May 2012Centers for Disease Control and Prevention, 2011
The Cost of Poor Nutrition
Chronic Disease Risk
Chronic Disease Risk
Reduced Quality of
Life
Reduced Quality of
Life
Significant Financial Impact
Significant Financial Impact
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Diet Planning Guides: History
o 1st rec., USDA, 1894
o 1917, “How to Select Foods”
o 1930s: scarcity, cost
o WWII: health of troops
o Evolved into RDAs
2010 DGAs: Key Recommendations
Balancing Calories
Enjoy your food, but eat less
Avoid oversized portions
Foods to Increase
Make half your plate fruits and vegetables
Switch to fat‐free or low‐fat (1%) milk
Foods to Reduce
Compare sodium in foods like soup, bread, and frozen meals – and choose the foods with lower numbers
Drink water instead of sugary drinks
DGAs 2010: Nutrients of Concern
Nutrients of Public Health Concern
Potassium
Dietary fiber
Calcium
Vitamin D
DGAs 2010: Sodium Guidelines
New Sodium Guidelines in 2010 DGA
2,300 mg per day for general population
1,500 mg for aged 51+, African Americans & HTN, diabetes & CKD
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Food Guides: The 4 Food Groups Food Guides: USDA FGP (1992)
Actual US FGP Intake Food Guides: MyPyramid.gov (2005)
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Food Guides: MyPlate (2011) ChooseMyPlate Food Groups
Healthy Eating Plate (Harvard)
World Cancer Research Fund/American Institute for Cancer Research
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Canada’s Food Guide
Chinese Food Pagoda
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An Understandable Food Pyramid? Food Labels
Dr. Ancel Keys
o 1904‐2004
o University of Minnesota
o WWII infamous “K ration”
o Post‐WWII “Biology of Human Starvation” (1950)
o Seven Countries Study
Research: The 7 Countries Study
o 1958‐1970, men 40‐59 in 18 areas of 7 countries
o First to explore associations among diet, risk & disease in contrasting populations
o Chemical analysis of foods + diet recall
o Demonstrated degree to which the diet – and in particular saturated fatty acids and cholesterol levels – predict present and future CAD
University of Minnesota, School of Public Health Our History available at: http://www.sph.umn.edu/epi/history/overview/
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Principles of the Med Diet
o Plant‐based diet with herbs & spices for flavor
o Limited red meat intake, focus on fish & poultry
o Low processed food intake, emphasizes fresh
o Includes foods from the sea
o Moderate dairy and wine
o Activity is part of a healthy lifestyle
o Focus on good fats: olive oil
Reproduced with permission of Oldways Preservation and Exchange Trust
Med Diet: Focus on Fats
o Total fat is 25‐35% of calorieso Saturated fat is no more than 7‐8% of calories
o Olive oil, nuts, seedso Limited animal foodso Monounsaturated fats are not alone protective against CVD, but lifestyle + foods together are
Med Diet: Focus on Alcohol
o Moderate consumption of wine
o Normally consumed with meals
o Moderation defined as:
• No more than 1 glass wine per day for women
• 1‐2 glasses wine per day for men
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Research: PREDIMED vs. Low-Fat
o 2006, PREDIMED Prevención con Dieta Mediterránea
o N=722 asymptomatic persons, 55‐80 at high CVD risk, randomized to low‐fat or 1 of 2 Med diets
o After 3 months follow‐up:• Weight/BMI same in 3 groups
• Lower BG, lower systolic BP, lower t‐chol/HDL ratios in 2 Med diet groups than low‐fat
• Inflammation markers also lower in 2 Med diets
Ann Intern Med. 2006 Jul 4;145(1):1‐11
Research: Metabolic Syndrome
o 2011, Meta‐Analysis of 50 studies and 534,906 individuals
o Effect of Mediterranean diet on metabolic syndrome and its components
o Adherence to Mediterranean diet was “highly protective”
o Showed 31% lower risk of developing metabolic syndrome
J Am Coll Cardiol. 2011;57(11):1299‐1313
Research: Hear t Disease
o 2013, n=7447 enrolled, aged 55‐80, 57% female
o Smokers, overweight, diabetes or risk factors
o Low fat diet group or 1 of 2 Med diet groups
o Meaningful endpoints: MI, stroke, death
o Findings: 30% of MI, stroke, death can be prevented if switch to Mediterranean diet
N Engl J Med. 2013;368:1279‐1290
For More Information
o University of Minnesota The Seven Countries Study in Brief: http://www.sph.umn.edu/epi/history/overview/
o Oldways What is the Mediterranean Diet? http://oldwayspt.org/programs/mediterranean‐foods‐alliance/what‐mediterranean‐diet
o American Heart Association Mediterranean Diet: http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Mediterranean‐Diet_UCM_306004_Article.jsp
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Coursera Nutrition Class
o https://www.coursera.org/course/nutrition
o Nutrition for Health Promotion & Disease Prevention
o 6‐week, free, massive open online course (MOOC) taught in conjunction with UCSF
o 21 CEUs for MDs, RDs, PharmDs, RNs, PAs
o Next start date: Late 2014