Chapter 10 NUTRITIONAL ASSESSMENT AND NEEDS

1. Chapter 10NUTRITIONAL ASSESSMENT AND NEEDS Pam Jackson

2. Introduction This presentation poses a series of questions about nutrition, for you to consider and investigate.

3. Obesity • Q. Is there a link between what we eat and our health? • Q. Does it matter what we eat? • Q. Is obesity an issue?

4. Obesity is an important public health problem that is linked with many serious health conditions • A recent report estimated that in England 30,000 deaths per year are related to obesity (BNF, 2005) • Young adults who are severely obese have 12 times the risk of mortality when compared to individuals of normal weight • Individuals who are overweight or obese are more likely to suffer from cardiovascular disease, type 2 diabetes, high blood pressure, stroke, some types of cancer and osteoarthritis

5. Fat • Q. How much fat is recommended in the British diet? • A. 15% • B. 25% • C. 35% • D. 45%

6. Current UK guidelines are: • To reduce total fat to about 35% or less of total energy intake • To reduce saturated fats to 10% of total energy intake • To reduce trans fatty acids to no more than 2% of total energy intake

7. Q. Are there any kinds of fat that are associated with health benefits?

8. Essential fatty acids such as Omega-3 have been found to reduce cardiovascular problems • Eating a small amount of oily fish each week reduces the risk of cardiovascular disease (Oomen et al, 2000; Hu et al, 2002) • In people with coronary heart disease, diets enriched with omega-3 fatty acids reduced the risk of death from myocardial infarction (Bucher et al, 2002). • The current UK recommendation is to eat one to two portions of oil-rich fish (such as mackerel, salmon, kippers, herring) and alpha-linolenic acid (the richest sources of which are seed oils, such as rapeseed and soya, and nuts, such as walnuts) per week

9. Q. Does it make a difference where fat is stored in the body? Apple or pear?

10. It is not just a problem of excess fat, but where that fat is. Adults who are ‘apple shaped’, with excess fat around their waist, are more at risk than those who are ‘pear shaped’ with extra fat around their hips and thighs. Waist circumference is often measured as part of a nutritional assessment. Men are more at risk of obesity-related diseases if their waist circumference is more than 94cm and women, if more than 80cm.

11. Diet Q. What does a healthy diet look like?

12. You can download this image from the companion website at: www.palgrave.com/glasper

13. Q. What size is a ‘portion’ for different fruits and vegetables?

15. Q. What evidence is there to suggest that poor nutrition is associated with increased health risks?

16. CARDIOVASCULAR DISEASE • Reducing dietary fat intake reduces the risk of cardiovascular disease, although, does not appear to affect mortality rate (Hooper et al, 2001) • A diet that contains plenty of fruit and vegetables, nuts, fish and mono-unsaturated vegetable oils, and with limited dairy products and meat, is good for the heart (Trichopoulou et al, 2003; Singh et al, 2002)

17. HYPERTENSION • For moderately overweight people, losing weight and keeping lost weight off can substantially reduce the risk of becoming hypertensive in the future (Moore et al, 2005) • There appears to be a consistent relationship between weight loss and reductions in both systolic and diastolic blood pressure (Neter et al, 2003)

18. TYPE 2 DIABETES MELLITUS • Individuals with Type 2 Diabetes are advised to eat a healthy diet and take regular exercise • In a UK study, 1122 individuals were screened for glucose tolerance: 4.5% had Type 2 Diabetes and a further 17% had impaired glucose tolerance • those who ate salad/vegetables daily, had a lower incidence of glucose intolerance (13% compared to 17%) • only 1% of those who ate salad daily, compared to 6% of infrequent salad eaters, had Type 2 Diabetes (Williams et al, 1999)

19. CANCER • Epidemiologic studies indicate that a high intake of saturated fat increases the risk of colon and breast cancer • The advice of the World Cancer Research Fund is to limit intake of red meat and meat products to below 80g a day • Reducing fat intake improved survival of breast cancer patients (Chlebowski et al, 2006) • Risk of colon cancer is greater in red meat eaters compared to non red meat eaters, and eating poultry/fish is associated with a lower risk (Chao et al, 2005) • Increased fruit and vegetable intake appears to protect against risk of cancer (Riboli & Norat, 2003) • Eating fish appears to reduce the risk of colorectal cancer (Norat et al, 2005) • Eating more than four servings of whole grain food a week reduces the chance of getting most cancers (Jacobs et al, 1998)

20. Q. Is there a link between bone health and fruit and vegetable consumption?

21. Osteoporosis and fractures in later life are directly related to bone mass and diet is key, especially calcium intake during puberty, when the majority of skeletal mass is deposited (Gregory et al, 2000) • Calcium is found in milk and dairy products and bread • Vitamin D Is found in dairy and fortified margarines • Several population-based studies have demonstrated the beneficial effects of fruit & vegetables on bone health in children, women and elderly • increasing fruit and vegetable intake from 3.6 to 9.5 daily servings significantly decreased calcium excretion in the urine and reduced bone turnover (Lin et al, 2001)

22. Conclusion • Nutrition and health - eating matters! • It is possible to have good nutritional status in the absence of good health, but optimal health is impossible in the absence of good nutritional status (Dickerson, 1995) • We, as health care professionals, have a responsibility to minimise the effects of poor nutrition

23. References • Bucher et al (2002) ‘N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials’, American Journal of Medicine 112: 298-304. • Chlebowski et al. (2006) Journal of the National CancerInstitute98(24): 1767-76 • Chao et al (2005) Journal of the American Medical Association293(2): 172-82. • Gregory et al (2000) • Hooper et al. (2001) ‘Dietary fat intake and prevention of cardiovascular disease: systematic review’, British Medical Journal322: 757-763. • Hu et al. (2002) ‘Fish and omega-3 fatty acid intake and risk of coronary heart disease in women’, Journal of the American Medical Association287: 1815-1821. • Jacobs et al. (1998) Whole-grain intake and cancer: an expanded review and meta-analysis. Nutrition and Cancer30: 85-96. • Lin et al (2001) • Moore et al. (2005) Archives of Internal Medicine,165: 1298-1303. • Neter et al. (2003) ‘A meta-analysis of randomised controlled trials’. Hypertension42 • Norat T et al. (2005) ‘Meat, fish, and colorectal cancer risk: the European prospective investigation into cancer and nutrition’, Journal of the National Cancer Institute97: 906-916. • Oomen C et al. (2000) ‘Fish consumption and coronary heart disease mortality in Finland, Italy and the Netherlands’, American Journal of Epidemiology,151: 999-1006. • Riboli E, Norat T. (2003) ‘Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk’, American Journal of Clinical Nutrition78(suppl): 559S-569S. • Singh RB et al. (2002) ‘Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients’, Lancet360: 1455-1461. • Trichopoulou A et al. (2003) ‘Adherence to a Mediterranean diet and survival in a Greek population’, New England Journal of Medicine348: 2599-2608. • Williams DE et al. (1999) Journal of Clinical Epidemiology 52: 329-335.