1. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 1 Chapter 1 Food, Nutrition, and Health We are what we eat…

2. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.2 Nutrition and Dietetics Nutrition –Ingesting nutrients, restructuring them, and then using them for our body’s benefit –Food people eat and how the body uses it Nutrition science –Scientific knowledge about food requirements for human growth, development and maintenance

3. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.3 Nutrition and Dietetics, cont’d Registered Dietitian (RD) –Nutrition authority on the health care team –Other terminology Clinical nutrition specialist or public health nutritionist (make sure RD is credentialed) Dietetics –Field that applies nutrition science to human health and assists in disease management

4. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.4 Health and Wellness Proper nutrition is essential to good health which includes meeting basic human needs Wellness seeks the full development of health potential for all persons A balance between activities and goals Response to medical care system’s focus on illness and disease The focus is on lifestyle and personal choices

5. Healthy People 2010 Encourages healthy choices in: –Diet –Weight control –Decreasing risk factors for disease

6. HEALTHY PEOPLE 2020 http://www.healthypeople.gov/2020/TopicsObjectives2020 /pdfs/HP2020_brochure_with_LHI_508.pdfhttp://www.healthypeople.gov/2020/TopicsObjectives2020 /pdfs/HP2020_brochure_with_LHI_508.pdf 12 new topics added to Healthy People 2010: Access to health care; oral health; Clinical preventive services; tobacco; environmental quality; injury & violence; WIC health; mental health; nutrition, physical activity, & obesity; reproductive & sexual health; social determinants; substance abuse.

7. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.7 Traditional and Preventive Approaches to Health Traditional –Attempts change only when illness or disease already exists and has little value for lifelong positive health Preventive –Identifies risk factors and allows people to choose behaviors to minimize risk of disease

8. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.8 Signs of Proper Nutrition Well-developed body Ideal weight for body composition Adequate muscle development Smooth skin, glossy hair, clear and bright eyes Mental and physical alertness Ability to resist disease Increased life span

9. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.9 Nutrients in Food Provide energy Provide amino acids to build tissue Regulate metabolic processes Individual nutrients with specific metabolic functions No nutrient ever works alone –Iron & Vitamin C –Calcium & Vitamin D

10. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.10 Energy Sources Carbohydrates –Primary source of fuel for heat and energy –Maintain body’s back-up store of quick energy –Should provide 45% to 65% of total kilocalories

11. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.11 Mosby items and derived items © 2006 by Mosby, Inc. Slide 11 Energy Sources, cont’d Fats –Animal and plant sources –Secondary (storage) form of heat and energy –Should provide no more than 20% to 35% of total kilocalories

12. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.12 Energy Sources, cont’d Proteins –Primary function is tissue building and repair –Should provide 10% to 35% of total kilocalories –Source of energy when supply from carbohydrates and fats is insufficient

13. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.13 Tissue Building Proteins - provide amino acids -Necessary for building and repairing tissues Vitamins and minerals -Vitamin C for tissue building -Calcium and phosphorus for building / maintaining bone - Iron: Essential part of hemoglobin in the blood Fatty acids -Build central fat substance of cell walls

14. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.14 Regulation and Control Vitamins –Function as coenzyme factors Components of cell enzymes in governing a chemical reaction during cell metabolism Minerals - Also serve as coenzyme factors Water –Essential base for all metabolic processes Fiber -Regulates passage of food material through gastrointestinal tract

15. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.15 Types of Nutrition Health Optimal nutrition –Obtained from a varied and balanced diet Malnutrition –Improper or insufficient diet –Less than desired amounts of nutrients –Limits work capacity, immune system function, and mental activity –Lack nutritional reserves for extra demand on the body – illness, injury, or pregnancy

16. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.16 Types of Nutrition Health, cont’d Undernutrition –Reserves depleted; Nutrient and energy intake insufficient to meet daily needs/ metabolic stresses Overnutrition –Excess nutrient and energy intake over time –Produces harmful total body weight –Excessive amounts of nutrient supplements over time resulting in toxicity

17. Portion Distortion Comparison of Portions and Calories 20 Years Ago to Present Day 20 Years Ago Today PortionCaloriesPortionCalories Bagel3'' diameter1406'' diameter350 Cheeseburger13331590 Spaghetti w/meatballs 1 cup sauce 3 small meatballs 5002 cups sauce 3 large meatballs 1,020 Soda6.5 ounces8220 ounces250 Blueberry muffin 1.5 ounces2105 ounces500 Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.17 http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/eat-right/distortion.htm

18. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.18 Dietary Reference Intakes (DRIs) Published by the National Academy of Sciences and updated every 5 to 10 years Includes recommendations for each gender and age group for the minimum amount of nutrients to protect majority of persons from the risk of nutrient deficiency Encompasses four interconnected categories of nutrient recommendations

19. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.19 DRIs, cont’d Recommended Dietary Allowance (RDA) –Daily intake of nutrients that meet needs of almost all healthy individuals Estimated Average Requirement (EAR) –Intake level that meets needs of half the individuals in a specific group

20. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.20 MyPyramid Food guidance system released 2005 Valuable nutrition education tool for the public Goal is to promote physical activity, variety, proportionality, moderation, and gradual improvements Moving toward My Plate as a better visual aid for people

21. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.21 MyPyramid / My Plate

22. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.22 Dietary Guidelines for Americans, 2005 Established 1960s and updated every 5 yrs Based on nutrition choices to help prevent chronic health problems of an aging population Relate current scientific thinking to America’s health problems

23. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.23 Dietary Guidelines for Americans – Focus Areas Nine focus areas –Adequate nutrients within calorie needs –Weight management –Physical activity –Food groups –Fats –Carbohydrates –Sodium and potassium –Alcoholic beverages –Food safety

24. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.24 Changing Food Environment Heightened reliance on fast, processed, or pre-packaged foods Surveys indicate malnutrition in U.S., however the outlook is changing: –Fast food restaurants are beginning to offer lower-fat, health-conscious alternatives –Chain restaurants are developing new menu items – oatmeal for breakfast –Shoppers are using FDA’s nutrition labeling to make better choices

25. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.25 Summary Proper food and key nutrients are essential to life and health Registered Dietitian is the nutrition expert Proper nutrition requires carbohydrate, protein, fat, vitamins, minerals, and water in the proper combinations Established nutrient and food guides for health promotion

26. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved. 26 Chapter 13 Community Food Supply and Health “We think fast food is equivalent to pornography, nutritionally speaking.” ~Steve Elbert

27. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.27 Government Control Agencies Food and Drug Administration (FDA) – primary control of American food supply & quality USDA Food Safety and Inspection Service (FSIS) – meat and poultry National Marine Fisheries Service (NMFS)- fish Environmental Protection Agency (EPA) Federal Trade Commission (FTC) Centers for Disease Control and Prevention (CDC)

28. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.28 Food and Drug Administration Enforces food sanitation and quality control Controls food additives Regulates interstate food transport Maintains accurate nutrition labeling Ensures public food service safety Provides consumer education Performs research

29. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.29 Food Labels Two types of label information –Food standards: lists all ingredients (“standard of identity”) –Nutrition information: describes a food’s nutritional value and percentage of a 2000 Cal diet

30. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.30 Current Food Label: Nutrition Facts

31. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.31 Food Label: Health Claims Strictly regulated by FDA for accuracy If claims make an association between a food product and a specific disease: –FDA must approve claim –Food must meet criteria set forth for that claim –Wording on package must be approved

32. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.32 Food Technology Agricultural and food processing industries have developed chemicals to increase and preserve food supply. Critics are concerned about how these changes have affected food safety and the environment. –Pesticides –Food additives

33. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.33 Agricultural Pesticides Goal is to increase food production for a growing population Pros: Pesticides improve crop yields –Example: Chemicals destroy many destructive insects Cons: –Pesticide residue on food –Gradual leaching of chemicals into ground water and wells

34. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.34 Alternative Agriculture Organic farming –Grow foods without synthetic pesticides, fertilizers, sewage sludge, bioengineering, or ionizing radiation –Raise animals and produce dairy products without antibiotics or growth hormones –Use manure from organic animals to fertilize fields Natural pest control may be used – aphids, spiders, bats

35. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.35 Alternative Agriculture, cont’d Genetic modification –Reduces the need for toxic pesticides and herbicides –Example: Genetically modified corn that expresses a protein that acts as an insecticide –Seedless oranges, grapes and watermelons are genetically modified.

36. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.36 Alternative Agriculture, cont’d Irradiation – used since 1960s –Kills bacteria and parasites on food after harvest –Prevents food-borne illness –Can increase shelf life of produce Foods that are irradiated have: –Unaltered nutritional value and are not radioactive –No harmful substances introduced as a result of irradiation –May taste slightly different to some people

37. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.37 Food Additives Chemicals intentionally added to foods to prevent spoilage and extend shelf life Benefits include: –Enriched food with added nutrients (sugar) –Uniform quality of food –Standardized functional factors (e.g., thickening) –Preserves foods (ex: salt) –Controls acidity and alkalinity to improve flavor and texture

38. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.38 Food-Borne Disease 76 million people in the United States sickened with food-borne disease annually 325,000 U.S. hospitalizations annually $83 billion annually in medical costs and personal salary losses Salmonella, Campylobacter, Shigella, and Cryptosporidium

39. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.39 Buying and Storing Food Food should be of good quality. Dry or cold storage is best. Refrigerate promptly at 40° F or lower. Food does not need to cool before being placed in the refrigerator. Do not cross-contaminate foods, wash hands and counter surfaces. Cook to proper temperatures. Do not eat food that has been above 40° F for more than 4 hours. (4x4 ‘rule’)

40. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.40 Food Contamination Food-borne illness usually presents with flulike symptoms High-risk individuals: Age & physical condition –Young children –Pregnant women –Elderly –Individuals with compromised immune systems

41. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.41 Bacterial Food Infections Salmonellosis –Caused by Salmonella, which grow readily in milk, custard, egg dishes, salad dressing, sandwich fillings, seafood from polluted waters & undercooked chicken –Unsanitary food handling can spread bacteria

42. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.42 Bacterial Food Infections, cont’d Shigellosis –Caused by Shigella, which grow easily in milk –Most common in young children –Usually confined to large intestine

43. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.43 Bacterial Food Infections, cont’d Listeriosis –Caused by Listeria –Grows in soft cheese, poultry, seafood, raw milk, commercially broken and refrigerated raw eggs, meat products (such as pâté)

44. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.44 Bacterial Food Poisoning, cont’d Clostridial food poisoning –From Clostridium perfringens and Clostridium botulinum –C. perfringens are widespread in environment –C. botulinum cause botulism (serious, often fatal food poisoning)

45. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.45 Viruses Viral infectious hepatitis Caused by fecal contamination of water, milk, or food or by contaminated shellfish from polluted waters

46. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.46 Environmental Food Contaminants Lead –Sources include lead paint, airborne lead particles, water from lead pipes Mercury –Sources include fish from contaminated water

47. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.47 Parasites Roundworms –Example: Trichina worm found in pork Flatworms –Example: Tapeworms in beef and pork Do not eat undercooked pork or beef.

48. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.48 Key Concept Poverty often prevents individuals and families from having adequate access to their surrounding community food supply causing undernutrition. The World Food Summit works to eliminate hunger and establish sustainable food supplies by 2015.

49. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.49 Food Needs and Costs Worldwide hunger and malnutrition –Lack of sanitation –Cultural inequality –Overpopulation –Economic and political structure / unrest –Chronic food or nutrient shortages In the United States –More than 11 million households defined as “food insecure” in 2000

50. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.50 Food Assistance Programs Commodity Supplemental Food Program Food Stamp Program Special Supplemental Food Program for Women, Infants, and Children National School Lunch, Breakfast, and Special Milk Program Nutrition Services Incentive Program

51. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.51 Food Buying and Handling Plan ahead to control impulse buying. Eat before you go food shopping! Buy wisely. –Understand packaging, labels, brands, portion yields, measures, and food values. –Only buy in quantity if savings will be achieved. Store food safely. Cook food well.

52. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.52 Summary Common public have concerns regarding the safety of the community food supply center on the use of pesticides and food additives. These substances have produced an abundant food supply but have brought dangers and require control. The FDA is the main government agency established to maintain control. The FDA also conducts activities related to areas such as food safety, food labeling, food standards, consumer education, and research.

53. Copyright © 2009, by Mosby, Inc. an affiliate of Elsevier, Inc. All rights reserved.53 Summary, cont’d Numerous organisms can contaminate food and cause food-borne illness. –Bacteria –Viruses –Parasites Rigorous public health measures control sanitation, food areas and personal hygiene of workers. U.S. food assistance programs are available for families under economic stress.