1. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
OVERVIEW OF HEALTHY EATING HABITS
CHAPTER 1
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

2. Role of the Dental Hygienist
Identify harmful dietary habits that may initiate oral disease
Promote health and wellness as a health professional
Opportunity to see patients on a more regular basis than many other health professionals
Support interventions initiated by other health care professionals
Identify patients needing referral to a registered dietitian for complex nutrition needs that may ultimately affect general health
A nutritionist has at least a 4-year degree in foods and nutrition and usually works in a public health setting assisting people in the community, such as pregnant teenagers or older persons, with diet-related health issues. In many states nutritionists are legally defined and is licensed or certified. They work in local or state health departments and in the extension service of a land-grant university. A registered dietitian (RD) has completed a minimum of a bachelor’s degree in foods and nutrition in addition to a minimum of 800 hours of clinical training in normal and clinical nutrition, food science, and food service management and advanced training in medical nutrition therapy.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

3. Basic Nutrition Nutrition Essential nutrients
Process by which living things use food to obtain nutrients for energy, growth, and maintenance
Essential nutrients
Substance obtained from food that the body cannot produce in sufficient quantities to meet physiological requirements
Some nutrients can be converted by the body to meet its physiological needs.
Essential nutrients are needed on a regular basis. Nonessential nutrients can be used but are either not required or can be synthesized from dietary precursors. Precursors are substances from which an active substance is formed.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

4. Classes of Nutrients Macronutrients Micronutrients Water* Proteins
Carbohydrates
Fats
Alcohol
Micronutrients
Minerals
Vitamins
Foods are used for energy, tissue building, and as regulatory substances
*Water is the most important nutrient. Following water, the nutrients of priority are those that supply energy. These are obtained from foods or from quantities stored in the body.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

5. Basic Concepts of Nutrition
Good nutrition evaluated in context of patient’s:
Physiological needs for essential nutrients
Nutrient content of the food
Cultural or environmental circumstances
Personal preferences
Encourage variety of foods to minimize nutrient deficiencies or excesses
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

6. Governmental Nutrition Concerns
Prior to 1977 main concern was nutrient deficiencies, e.g., pellagra
Current concern is prevention of chronic diseases related to dietary intake including:
Cancer, stroke, diabetes mellitus, atherosclerosis, and coronary artery disease
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

7. Healthy People 2010 Nutrition Objectives
Objectives involving nutrition included in 21 priority areas
Oral health and nutrition objectives
Reduce proportion of children and adolescents who have dental caries
Increase numbers of community water systems containing optimal amounts of fluoride
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

8. Dietary Reference Intakes (DRIs)
Estimated average requirement (EAR)
Amount of nutrients estimated to meet needs of half of healthy individuals in specific age and gender group
Recommended dietary allowances (RDAs)
Sufficient amount of nutrients to meet requirements of nearly all (97%–98%) healthy individuals
Dietary reference intakes are a revised set of nutrient-based reference values. (See p. i.)
Estimated average requirements: the amount of a nutrient that is estimated to meet the needs of half of the healthy individuals in a specific age and gender group.
Recommended dietary allowances: previously focused on amounts of nutrients necessary to prevent deficiency disease. The new RDA is generally higher than the EAR and provides a sufficient amount of nutrients to meet the requirements of nearly all (97%-98%) healthy individuals. Provides a generous margin of safety.
No health benefits are established for consuming intakes above the RDA.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

9. Dietary Reference Intakes (DRIs)
Adequate intake (AI)
Average amount of nutrient that appears to maintain a defined nutritional state; more tentative than an RDA
Tolerable upper intake level (UL)
Maximum daily level of nutrient intake that probably will not cause adverse health or toxic effects for most individuals
Adequate intake: the average amount of nutrient that appears to maintain a defined nutritional state. AI exceeds average requirements of virtually all members of a life/gender group but more tentative (subject to change) than an RDA.
Tolerable upper intake level: the maximum daily level of nutrient intake that probably will not cause adverse health or toxic effects for most individuals. Risk of adverse effects increases as intake exceeds the UL. The term “tolerable intake” avoids the implication that higher levels than the UL would be beneficial. Useful because of increased consumption of dietary supplements and fortified foods.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

10. Dietary Reference Intakes (DRIs)
Acceptable macronutrient distribution range (AMDR) (see Table 1-1)
Ensures sufficient intake of essential nutrients while reducing risk of chronic disease
Estimated energy requirement
Energy intake that is predicted to maintain energy balance
AMDR: established for the macronutrients, fat, carbohydrate, protein, and two polyunsaturated fatty acids to ensure sufficient intakes of essential nutrients while reducing risk of chronic disease. Macronutrients are the energy-providing nutrients needed in larger amounts, whereas micronutrients are less, such as vitamins and minerals (see Table 1-1).
Estimated energy requirement: the dietary energy intake predicted to maintain energy balance in healthy normal-weight individuals of a defined age, gender, weight, height, and physical activity consistent with good health. (see second page inside front cover) Because energy requirements are dependent on activity level, four different activity levels are listed.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

11. DRIs: Dental Hygiene Considerations
Guidelines apply to average daily intakes
Individual’s specific requirement unknown
Encourage a variety of healthy food choices
DRIs are guidelines for healthy people
UL may be used to warn patients against megadoses of nutrients
Dietary reference intakes are a revised set of nutrient-based reference values (see p. i).
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

12. Dietary Guidelines for Americans 2005
Issued by USDA and HHS; updated every 5 years
Authoritative advice for people 2 years and older about how good dietary habits can promote health and reduce risk for major chronic diseases
Dietary Guidelines for Americans are aimed to prevent disease and promote health and support an active lifestyle by the recommendations listed: eating lots of fruits, vegetables, whole grains, and low-fat or nonfat dairy products. Cruciferous vegetables include cabbage and broccoli and help reduce cancer susceptibility. The guidelines also emphasize balancing the foods you eat with your activity to maintain your weight, drinking alcohol in moderation if at all, and limiting foods high in salt, saturated fat, trans fat cholesterol and added sugar. Activity is also an important part of the picture. The guidelines suggest a minimum of 30 minutes a day to reduce disease risk and 60 to 90 minutes a day to maintain or lose weight. These are updated every 5 years to promote health and reduce risk for major chronic diseases. The Dietary Guidelines for Americans are the foundation for Food Pyramid Guidance System, also released in 2005 that assists consumers to become healthier by applying nutrition science to their own lives. The guidelines for 2005 include 9 focus areas with 23 key recommendations. In general, the message is simple: monitor portion size, be more active, and eat a variety of foods. The guidelines support healthy eating habits to improve health and quality of life, as shown in the sample menu in Fig. 1-2. .
U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, th ed. Washington, D.C.: U.S. Government Printing Office, January 2005
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

13. Dietary Guidelines for Americans 2005
Key recommendations
Adequate nutrients within kilocalorie needs
Weight management
Physical activity
Food groups to encourage
Fats and carbohydrates
Sodium and potassium
Alcoholic beverages
Food safety
Adequate nutrients and caloric needs: meeting nutrient recommendations must be balanced with keeping caloric levels under control. Food choices need to change when caloric levels are decreased to include foods containing more nutrients.
Weight management: to reverse obesity trend or maintain healthy weight, most Americans need to eat more fruits and vegetables, engage in more physical activity and reduce the consumption of high-calorie foods and sugar-sweetened beverages.
Physical activity: Americans are relatively inactive. Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a health body weight.
Food groups to encourage: adding more fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products may have beneficial health effects. These food groups provide good sources of the nutrients frequently lacking in American diets.
From U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, th ed. Washington, D.C.: U.S. Government Printing Office, January 2005.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

14. Dietary Guidelines for Americans 2005: Dental Hygiene Considerations
Apply only to healthy individuals >2 years of age
Encourage nutrient-dense food: whole grains, fruits, and vegetables
Encourage moderation in salt, sugar, and alcohol intake
Encourage intake of fluoridated water
Encourage patients to consume more dark green and orange vegetables, legumes, fruits, whole grains, and low-fat milk and milk products.
Encourage patients to consume less refined grains, total fats (especially saturated and trans fats), added sugars, and kilocalories.
patient needing 2,000 kcal daily should limit saturated fat intake to 20 g or less.
Carbohydrate-containing foods—fruits, vegetables, grains, and milk—are important sources of many nutrients, but carbohydrate selections should be chosen wisely, within the context of a calorie-controlled diet.
By reducing the frequency and duration of oral exposure to fermentable carbohydrate intake and optimizing oral hygiene practices, such as drinking fluoridated water along with brushing and flossing teeth, dental caries can be minimized.
A person’s preference for salt is not fixed; the desire for salty foods tends to decrease after consuming foods lower in salt for a period of time.
Residual moisture on produce may promote survival and growth of microbes.
Dietetic, sugar‑free, or reduced fat products may not be low in kilocalories; this is dependent on other ingredients in the food.
Provide the patient with a definition or example of moderation (i.e., ¼ tsp salt per day or 5 oz glass of wine for a woman per day).
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

15. Food Pyramid System
Principal nutrient contributions of each food group (see Table 1-3). Foods providing similar kinds of nutrients are grouped together; therefore, foods in one group cannot replace those in another. Portion sizes are positively related to energy intake in children and adults. Larger portion sizes at restaurants or at home is one of the factors contributing to more overweight and obese people in the United States. Table also shows servings per day for different groups. A closer look at fats and added sugars. These foods provide kilocalories but few vitamins and minerals. They should be used sparingly.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

16. Food Pyramid System: Guiding Principles
Evolutionary
Useful
Realistic
Flexible
Practical
The guiding principles that underlie the development of MyPyramid are the same as they were for the original Food Guide Pyramid.
The bottom three blocks contain the three main focus areas [CLICK FOR ANIMATION]—overall health, up-to-date research, and total diet.
Overall health—MyPyramid is designed to promote well-being to maintain and improve overall health, rather than focus on a particular disease or condition.
Up-to-date research—MyPyramid is based on up-to-date research so that the guidance recommends appropriate levels of nutrients and other food components consistent with current scientific knowledge
Total diet—MyPyramid focuses on an overall diet, not just the foundation of nutrients needed. A total diet is balanced in essential nutrients while also specifying limits on other food components such as fats, cholesterol, and calories. Previous food guides (before the original pyramid) established foundation diets that were designed to meet needs for essential nutrients and allowed anything else (such as fats or sugars) to be eaten in addition.
The center blocks [CLICK FOR ANIMATION] identify principles that help make the guidance useful, practical, realistic, and flexible.
Useful—The guide should target an audience and should build on previous knowledge and food guides.
Realistic—Nutrient needs should be met from commonly consumed foods rather than from foods only rich in those particular nutrients.
Flexibility—Consumers should be able to make choices among foods so that they can eat foods they like while still meeting nutritional goals.
Practical—The guide should allow varying nutritional needs to be met by varying amounts served, rather than by selection of different foods.
The top block [CLICK FOR ANIMATION] notes the need to allow for evolution of the current guide—with time, changes will and can be made. A new food guide should be built on the success and concepts of previous guides. The release of MyPyramid is the first major evolution of the USDA’s food guide since the original pyramid, and it demonstrates how a new guide can change and yet build on previous success.
Overall Health
Up-to-Date Research
Total Diet
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

17. Food Pyramid System
MyPyramid was designed to help people make food choices for meeting nutrient requirements
Foods are grouped according to nutrient content
Each food group is identified by a unique color. This color is used in the graphic and in information about that group. The USDA encourages professionals to adopt this color coding when educating consumers about each group so that the colors become tied to the group, for easy reference.
Note that the narrow yellow band in the graphic represents oils. Although oils are needed in the diet as a source of important nutrients (essential fatty acids and vitamin E), they are not considered a food group.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

18. Food Pyramid System Message: Discretionary Calories
Total estimated
Discretionary = energy — Essential
calories requirement calories
Discretionary calories* may be used to:
Increase amount of food selected from a food group
Consume foods that are not in the lowest fat form—such as 2% milk or items that contain added sugars
Add oil, fat, or sugar to foods
Consume alcohol (for those who consume alcohol)
The concept of “discretionary calories” was first described by the 2005 Dietary Guidelines Advisory Committee.
When all food choices are in “nutrient-dense forms”—that is lean or low-fat, with no added sugars—then nutrient needs can be met with fewer calories than the amount required for energy balance. The calories needed to meet nutrient needs are called “essential calories.” By subtracting the essential calories from a person’s total energy requirements, the number of calories available for discretionary food choices can be determined.
This remaining balance of discretionary calories permits some choices of foods with higher levels of fat and some added sugar intake, or increased intake from any food group. These amounts of “extras” are lower than most Americans now consume, however.
As energy requirements increase with increased physical activity, the amount of discretionary calories increases. For example, in the 1800-calorie food intake pattern, there are about 200 discretionary calories, whereas in the 2200-calorie pattern, there are about 300.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

19. Food Pyramid System Message: Physical Activity
In the Dietary Guidelines:
Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and
a healthy body weight
In MyPyramid graphic:
Steps and person on them symbolize physical activity should be a part of everyday healthy living
The fourth message drawn from the Dietary Guidelines is physical activity.
In the Dietary Guidelines, regular physical activity is recommended to promote health and mental well-being.
In MyPyramid, steps up the side of the Pyramid and a person actively climbing the steps are included to represent the advice to engage in regular physical activity. [CLICK FOR ANIMATION] Physical activity is important to everyday living and can improve one’s health by reducing the risks for many diseases.
The Dietary Guidelines and MyPyramid encourage adults to engage in at least 30 minutes or more of physical activity on most, preferably all, days of the week. For children, the recommendation is 60 minutes on most, preferably all, days of the week.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

20. Food Pyramid System Message: Proportionality
In the Dietary Guidelines:
Adopt a balanced eating pattern
Sufficient amount of fruits and vegetables
3 or more ounce equivalents of whole-grain products per day
3 cup equivalents per day of fat-free or low-fat milk or milk products
In MyPyramid graphic:
Differing widths of the color bands
suggest about how much
food should be eaten from
each group
Another key message drawn from Dietary Guidelines recommendations is proportionality.
In the Dietary Guidelines adopting a “balanced eating pattern, such as the USDA food guide* or the DASH eating plan*” is recommended. Additional recommendations encourage consumption of more fruits, vegetables, whole grains, and fat-free or low fat milk products than are now consumed by most Americans.
In MyPyramid the proportionality message is portrayed by the varying thickness of the food group bands. [CLICK FOR ANIMATION] These widths suggest that a person should choose more from the bigger wedges and vice versa. However, these bands do not suggest exact proportions. They are just a general guide for proportions of food one should consume. The actual amounts that are recommended vary by age, sex, and activity level.
*NOTE TO PRESENTER: The term “USDA food guide” was used in the Dietary Guidelines because MyPyramid had not been released at the time the guidelines were issued. The USDA food guide is another name for the food intake patterns that form the basis for MyPyramid. DASH stands for Dietary Approaches to Stop Hypertension. More information about the DASH eating plan can be found at
NOTE TO PRESENTER: The “per day” recommendations are intended to be averages over time.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

21. Food Pyramid System Message: Moderation
In the Dietary Guidelines:
Limit intake of saturated and trans fats, and choose products low in these fats
Make choices of meat, poultry, dry beans, and milk products that are lean, low fat, or fat free
Choose and prepare foods and beverages with little added sugars or calorie sweeteners
In MyPyramid graphic:
Food group bands narrow from
bottom to top suggesting to eat
nutrient-dense forms of foods
Another key message drawn from the Dietary Guideline recommendations is moderation.
In the Dietary Guidelines, choosing foods that “limit intake of saturated and trans fats,” choosing meat, poultry, beans, and milk products that are “lean, low fat, or fat free,” and selecting “foods and beverages with little added sugars” is recommended.
In MyPyramid, moderation is depicted by the narrowing of the bands from bottom to top. [CLICK FOR ANIMATION] Foods within a food group can vary in the amounts of solid fats and added sugars they contain. The bottom, wider portion of each band represents the foods in the most nutrient-dense form—that is, containing little or no solid fats and added sugars. The top, narrow end of each band represents foods within the group with more solid fat and added sugars. For example, an apple would be at the bottom of the fruit band, sweetened applesauce higher in the band, and apple pie toward the top.
Selecting more foods from the bottom of the bands provides more nutrition from the calories consumed. However, the more active a person becomes the more items from the narrow end of the band can be eaten.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

22. Food Pyramid System: Dental Hygiene Considerations
Provide information to patients about MyPyramid as it relates to positive changes in dietary lifestyle changes
Use the Food Pyramid system to evaluate adequacy of a patient’s diet
Eliminating food groups may lead to inadequate intake of nutrients
If only nutrient-dense foods are selected,
discretionary kcal can be used on other foods
The slogan “Steps to a Healthier You” suggests improvement should happen in stages over time
Gradual improvement is portrayed by the slogan “steps to the healthier you,” which suggests changes can be made in stages or steps over time. These changes include awareness of what one is actually eating, a reminder to vary food intake and to exercise. No matter how small the step in the right direction, gradual improvement to one’s health can be made.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

23. Other Food Guides: Healthy Eating Pyramid
1. Start with exercise
2. Focus on food, not grams
3. Go with plants
Eat a plant-based diet 
4. Cut way back on American staples, e.g., red meat and refined sugars and grains
5. Take a multivitamin and maybe have a drink
The Healthy Eating Pyramid was created by the faculty in the Department of Nutrition at the Harvard School of Public Health. Based on the latest science, the Healthy Eating Pyramid is a simple guide to choosing a healthy diet. Its foundation is daily exercise and weight control. The pyramid builds from there, showing that you should eat more foods from the bottom part of the pyramid (vegetables, whole grains) and less from the top (red meat, refined grains).
Copyright © 2008 Harvard University. For more information about the Healthy Eating Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health, and Willett W, Skerrett P: Eat, Drink, and Be Healthy. Free Press/Simon & Schuster Inc, 2005.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

24. Other Food Guides: Eating Well with Canada’s Food Guide
Steps toward better health and a healthy body weight include:
Eat recommended amount and types of food each day
Limit foods and beverages high in calories, fat, sugar or salt (sodium)
Be active every day
The Canada Food Guide is illustrated as a rainbow with 4 groups: grains (yellow), fruits and vegetables (green), milk group (blue), and meats and alternatives (red). It focuses on intake of dietary intake of vitamins, minerals, and other nutrients. Reducing the risk of obesity, type 2 diabetes, heart disease, certain types of cancer, and osteoporosis promotes overall health and vitality.
From Eating Well With Canada’s Food Guide (2007), Health Canada. Reproduced with permission of the Minister of Public Works and Government Services Canada, 2009.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

25. FDA Authorized Health Claims
Qualified health claims
Cancer risk
Cardiovascular disease risk
Cognitive function
Diabetes
Hypertension
Neural tube birth defects
(Box 1-4) Food label terminology: A label cannot include an explicit or implied nutrient claim unless it uses terms that have been defined by the FDA such as “free,” “more,” or “reduced.”
FDA authorized claims: Only health claims that have been approved and authorized by the FDA can be used on food products and dietary supplements.
The FDA is expected to establish definitions regarding carbohydrate content of foods so that consumers can make informed choices based on their own preferences and goals.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

26. Nutritional Label Daily reference values Based on 2000-calorie diet
% DV helps determine if a serving of food is high or low in a nutrient
These labels provide nutrition information needed by the general population to follow general recommendations. Approximately 65% of consumers indicate they frequently refer to the Nutrition Facts panel when making decisions about purchasing or consuming a food or beverage.
The labeling policy requires that approximately 90% of all foods, including some fresh produce, meat, and fish, provide nutritional information based on the nutrients provided in a single serving. For foods that are not packaged, the information must be displayed at the point of purchase (e.g., in a counter card, sign, or booklet).
From the Department of Health and Human Services, Food and Drug Administration. How to Understand and Use the Nutrition Facts Label. June 2000, updated July 2003 and November Available:
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

27. Which has more calories. Which one has more saturated fat
Which has more calories? Which one has more saturated fat? Which one has more calcium?
From the Department of Health and Human Services, Food and Drug Administration. How to Understand and Use the Nutrition Facts Label. June 2000, updated July 2003 and November Available:
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.