Nutrition and Obesity David Freestone, DO PGY 1 UNSOM Dept. of Pediatrics.
-
Upload
esteban-mullenix -
Category
Documents
-
view
221 -
download
3
Transcript of Nutrition and Obesity David Freestone, DO PGY 1 UNSOM Dept. of Pediatrics.
Nutrition and ObesityDavid Freestone, DOPGY 1 UNSOM Dept. of Pediatrics
ACGMEPatient Care
Medical Knowledge
Practice Based Learning and Improvement
Systems Based Practice
Professionalism
Interpersonal Skills and Communication
ObjectivesBrief overview of general nutrition
Understand consequences of poor diet
Understand what components of diet most contribute to obesity in pediatrics
Know what AAP guidelines are regarding prevention and treatment of obesity
Know local resources available to us in helping overweight/obese in Las Vegas
NutritionWho here has taken a course on nutrition?
A class?
A lecture?
Heard the word nutrition in medical school?
NutritionYet who feels that “good nutrition” correlates with “good health”?
Who here feels that they have a healthy lifestyle with good nutrition?
Why I am interested in nutrition
Undergraduate Ethnobotany
Study of culture and botany
A whole new world opened up to me describing how we use plants with focus on agriculture and medicine
Shamans use of plants and herbs for healing is basis for a lot of medicinal compounds used today.
Instead of a pill they would use mixtures of plants in belief that there would be a synergistic effect to the desired primary healing component.
This really made me think about what I put in my body
The Western DietProcessed Foods
Refined grains
Saturated fats and transfats
Lots of meat
High starch
Low fiber
High fructose corn syrup in everything
The Western DietGoogle search:
How Western Diets are Making the World Sick
Western Diet Ups Heart, Diabetes Risk
The western diet and lifestyle and diseases of civilization
Western Diet Tied to Intestinal Disease and Allergies
Western diet changes gut bacteria and triggers colitis in those at risk
Western Diet Linked to Inflammatory Bowel Disease
Diet Related Conditions(Not an all encompassing list)
Behavior
Allergies
Malnutrition/deficiencies
Cancers
CAD
Obesity
Metabolic syndrome
Government Recommendations (USDA)
SuperTracker:
My foods. Get your personalized nutrition and physical activity plan.
My fitness. Track your foods and physical activities to see how they stack up.
My health. Get tips and support to help you make healthier choices and plan ahead.
Government Recommendations
“The thing to keep in mind about the USDA [recommendations] is that it comes from the Department of Agriculture, the agency responsible for promoting American agriculture, not from agencies established to monitor and protect our health…. What’s good for some agricultural interests is not necessarily good for the people who eat their products.” – Chair of the Department of Nutrition at Harvard School of Public Health
Nutrition & ResearchWhere does nutrition fit?
NIH distributes funds for research.
Out of 27 institutes and centers…
Nothing is dedicated to nutrition alone.
Under Health information on Child and Teen the closest topic to nutrition is “Alcohol abuse”.
AAP GuidelinesNutrition and obesity-related Policy Statements:
Breastfeeding and the Use of Human Milk
Expert Committee Recommendations on Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity
Dietary Recommendations for Children and Adolescents (By AHA endorsed by AAP)
Prevention of Pediatric Overweight and Obesity
Active Healthy Living
Bright Bodies – Promoting Healthy Nutrition
These are a few of many helpful documents
Obesity
Obesity
Skin Acanthosis nigricans
Major dietary contributors of obesity and metabolic syndrome
Toward a Unifying Hypothesis of Metabolic Syndrome. Pediatrics. Feb. 2012
Branched Chain Amino Acids, Trans-fats, Ethanol
Fructose
Consumption trends parallel raise of obesity and metabolic syndrome
Partially converted to glucose, mainly converted to Fructose-1-phosphate (insulin independent)
Lipogenic precursors are created in liver leading to steatosis.
All 4 macronutrients overwhelm mitochondrial function resulting in ROS generation, excessive Denovo Lipogenesis, and impaired β oxidation.
Major dietary contributors of obesity and metabolic syndrome
Toward a Unifying Hypothesis of Metabolic Syndrome. Pediatrics. Feb. 2012
Branched Chain Amino Acids, Trans-fats, Ethanol
Fructose
Consumption trends parallel raise of obesity and metabolic syndrome
Partially converted to glucose, mainly converted to Fructose-1-phosphate (insulin independent)
Lipogenic precursors are created in liver leading to steatosis.
All 4 macronutrients overwhelm mitochondrial function resulting in ROS generation, excessive Denovo Lipogenesis, and impaired β oxidation.
Prevention of Metabolic Syndrome
Decrease substrate consumption
Particularly lipogenic substrate
Reduction in hepatic substrate flux
Increase fiber
↓Glycemic load (glycemic index × CHO(gm)/100)
↓lipogenesis and hepatic lipid export
Increase substrate clearance
Exercise
DRI Macronutrient Requirements
Age/Group Carbohydrates (g/d) Fiber (g/d) Fat (g/d) Protein (g/d)
0-6 mo 60 ND 31 9.1
6-12 mo 95 ND 30 11
1-3 y 130 19 ND 13
4-8 y 130 25 ND 19
Male 3-13 y 130 31 ND 34
14-18 y 130 38 ND 52
Female 9-13 y 130 26 ND 34
14-18 y 130 26 ND 46
ND = Not determinable due to lack of data of adverse effects in this age group and concern with regard to lack of ability to handle excess amounts. Source of intake should be from food only to prevent high levels of intake.
Expert Committee Recommendations:Eating, physical activity, and sedentary behaviors
Limit consumption of sugar-sweetened beverages
Encourage 9 servings a day of fruits and vegetables
limit screen time. (AAP recommends <2 hours)
Eat breakfast daily
Limit eating out
Encourage family meals
Limit portion size
Include high fiber diet
Balance macronutrient intake
60 minutes of moderate to vigorous activity daily
Limit consumption of energy-dense foods
Expert Committee Recommendations:Primary care providers
Assess obesity risk of all patients
Provide anticipatory guidance on healthy behavior
Check BMI at each well-child visit
Don’t treat obesity like AOM
Use the chronic care model
Chronic Care Model
Family/PatientSelf Management
EnvironmentFamilySchool
WorksiteCommunity
Medical SystemInformation systemsDecision supportDelivery system designSelf-management support
Expert CommitteeStudies since recommendations show that there is mixed adherence
Mainly surveys and no RCT
Obesity programs are following the expert committee recommendations while primary care is about 50%
No data to support effectiveness of recommendations, but a lot of data are used to create recommendations
We won’t know if it works unless we try
Management programs
Let’s Move
Bright Bodies
Smart Moves
5, 2, 1, 0
Focus on a Fitter Future: A Survival Guide to Planning, Sustaining, and Building a Pediatric Obesity Program.
Study assessing these programs declared:
“Effectiveness was greater when program objectives were specific, implemented across the school environments, extended into the community, and were culturally relevant”
Local ResourcesHealthy Hearts ProgramChildren's Heart Center
Guide To A Healthy Lifestyle
Achieving A Healthy Weight
Healthy Meals In Minutes
Recommended Reading For Parents
What Do Healthy People Do?
What's A Parent To Do?
Preventive Cardiology For Children
Healthy Lifestyles Newsletter
Criteria for referralBMI > 95th percentile (obesity not a diagnosis)
(Metabolic syndrome)HyperlipidemiaHypertensionFamily history of cardiac risk factorsCardiac RehabAges
Nutrition consult: 0-18 years12-week program: ages 7-18
Laboratory MarkersGlucoseLFT’sFasting lipid panelInsulinHgA1CThyroid panelHigh Sensitivity (Cardio) CRP
How it works…Referred to CHC by pediatrician
OV with pediatric cardiologist(EKG, Echo, Labs)
Nutrition Consult with R.D.
F/U x 3 months with R.D. Enroll into 12-week program
SummeryWe have patients who are overweight, obese, and/or at risk of becoming overweight or obese.
We need to be able to identify these patients
We need to educate on proper nutrition and healthy lifestyle.
We need to know resources available to us.
We need to constantly reevaluate how our methods are working for our patients.
Things to watch forAAP Committee on Nutrition will release statement on nutrition recommendations for children ≤4 yrs for preventing obesity in the coming months.
ReferencesCox P, Balik M. Plants, People, and Culture: The Science of Ethnobotany. New York : Scientific American Library;1997
Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st centery. Am J Clin Nutr 2005;81:341–54.
www.google.com re:western diet
Greene A. Feeding Baby Green – The Earth-Friendly Program for Healthy, Safe Nutrition During Pregnancy, Childhood, and Beyond. San Francicso: Jossey-Bass; 2009.
McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial(2007) Lancet, 370 (9598), pp. 1560-1567.
Environmental and Nutritional Diseases. In: Robbins SL, Kumar V, Abbas AK, Cotran RS, Fausto N. Robbins and Cotran: Pathologic Basis of Disease ed. 8. Philadelphia: W.B. Saunders Company, 2010. eBook.
http://www.choosemyplate.gov/
http://www.nih.gov/icd/
AAP Policy Statement: Breastfeeding and the Use of Human Breast Milk. Pediatrics vol. 115:496-506, 2005.
Barlow SE. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics vol. 120:S164-192, 2007.
Gidding SS, Dennison BA, Birch LL et al. Dietary Recommendations for Children and Adolescents, A Guide for Practitioners, Consensus Statement from the American Heart Association. Circulation vol112:2061-2075, 2005
AAP Committee on Nutrition: Prevention of Pediatric Overweight and Obesity. Pediatrics vol. 112:424-30, 2003.
AAP Council on Sport Medicine and Fitness and Council on School Health. Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity. Pediatrics. vol. 117:1834-42, 2006.
Bremer AA, Mietus-Snyder M, Lustig R. Toward a unifying Hypothesis of Metabolic Syndrome. Pediatrics vol. 129:557-570, 2012.
Lustig R. Fructose: Metabolic, Hedonic, and Societal Parallels with Ethanol. Journal of the American Dietetic Association vol 110:1307-21, 2010.
Johnson T, Weed LD, Touger-Decker R. School-based interventions for overweight and obesity in minority school children. J Sch Nurs. 2012 Apr;28(2):116-23. Epub 2011 Oct 24.
Kranz S, Brauchla M, Slavin JL, and Miller KB. What Do We Know about Dietary Fiber Intake in Children and Health? The Effects of Fiber Intake on Constipation, Obesity, and Diabetes in Children. Adv Nutr January 2012 Adv Nutr vol. 3: 47-53, 2012.
Eisenmann JC. Assessment of Obese Children and Adolescents: A Survey of Pediatric Obesity-Management Programs. PEDIATRICS Vol. 128 No. S51-58, 2011
Rausch JC, Perito ER, Hametz P. Obesity Prevention, Screening, and Treatment: Practices of Pediatric Providers Since the 2007 Expert Committee Recommendations. CLIN PEDIATR vol. 50: 434-441, 2011
Questions?