Nutrition and Chronic Illness
Kathaleen Briggs Early, PhD, RD, CDE
Assistant Professor of Biochemistry and Nutrition
kearly@pnwu.org
Learning Objectives
o Upon completion of this module,
the student will be able to:
1. Explain the severity of the worldwide
obesity epidemic
2. Identify how chronic diseases can be
prevented by proper nutrition and lifestyle
3. Identify what dietary regimens are
beneficial for chronic disease management
4. Explain why breastfeeding is the best choice
for infant feeding
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Chronic Disease
o A long-term condition
– e.g., obesity, diabetes, and cardiovascular disease
o May be prevented or delayed with lifestyle changes
– e.g., healthier eating and more physical activity
o According to the WHO
“…by 2020, chronic diseases will account for almost
three-quarters of all deaths worldwide, and that 71% of
deaths due to ischaemic heart disease (IHD), 75% of
deaths due to stroke, and 70% of deaths due to diabetes
will occur in developing countries. The number of people
in the developing world with diabetes will increase by
more than 2.5-fold, from 84 million in 1995 to 228 million
in 2025. On a global basis, 60% of the burden of chronic
diseases will occur in developing countries.”
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Nutrition for Chronic Disease
Prevention and Treatment
o Nutrition is a widely accepted tool for prevention
of chronic diseases
o Nutrition is also very important for management
and treatment of a chronic diseases
o This presentation will discuss cardiovascular
diseases (e.g., heart disease and stroke), obesity
and diabetes, and how they can be prevented and
treated with nutrition
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Classification
BMI(kg/m�)
Principal cut-off points
Underweight
Additional cut-off points
<18.50
<18.50
<16.00
<16.00
Moderate thinness
16.00 - 16.99
16.00 - 16.99
Mild thinness
17.00 - 18.49
17.00 - 18.49
Severe thinness
Normal range
Overweight
18.50 - 24.99
≥25.00
Pre-obese
25.00 - 29.99
Obese
≥30.00
Obese class I
30.00 - 34-99
Obese class II
35.00 - 39.99
Obese class III
≥40.00
http://apps.who.int/bmi/index.jsp?introPage=intro_3.html
18.50 - 22.99
23.00 - 24.99
≥25.00
25.00 - 27.49
27.50 - 29.99
≥30.00
30.00 - 32.49
32.50 - 34.99
35.00 - 37.49
37.50 - 39.99
≥40.00
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Value of waist circumference
o Location of excess fat is
important
o If excess fat is mainly around
midsection = more likely to
develop health problems than if
excess fat is mainly around hips
and thighs
• Apple vs. Pear shapes
• True even if BMI falls within the
normal range
o Women: waist measurement of
more than 35 inches (88 cm)
o Men: waist measurement of
more than 40 inches (102 cm)
Higher risk body
shape
Lower risk body
shape
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Use BMI and Waist Circumference
o Use it with every patient visit
o Can identify those patients at risk for
chronic disease with confidence
o Should be incorporated into vital signs and
patient check-in procedures
o Quick, cheap, and easy to do!
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The role of genetics in body weight
o Epidemiological evidence shows that obesity,
excess energy (Calorie) intake, and sedentary
lifestyle are primary contributors to the chronic
disease epidemic
o 40% of BMI is attributable to independent
genetic influences
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Obesity and Nutrition Transition
“Obesity in the developing world can be seen
as a result of a series of changes in diet,
physical activity, health and nutrition,
collectively known as the 'nutrition transition.'
As poor countries become more prosperous,
they acquire some of the benefits along with
some of the problems of industrialized
nations.”
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Worldwide Obesity Epidemic
o 2.5 million deaths can be attributed to
overweight/obesity worldwide
o Nearly 70% of cases of CVD are associated with obesity
o Worldwide, more than 1.1 billion overweight adults
• At least 312 million of them are clinically obese
• By the end of 2010, an estimated 43 million children under
five will be overweight
o Obesity levels range from 20-30% in European
countries, to over 70% in Polynesia
o By 2015, the worldwide obese population will reach
1.5 BILLION
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Diabetes
o Characterized by increased blood glucose (sugar)
levels
o Due to
1. a lack of insulin (a hormone), which controls
blood glucose levels
And/Or
2. an inability of the body’s tissues to respond
properly to insulin (a state called insulin
resistance)
o The most common type of diabetes is type 2
o Diabetes can benefit from good nutrition
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Types of Diabetes
– Type 1 diabetes
• an autoimmune condition resulting in the need for
lifelong insulin therapy
– Type 2 diabetes
• Progressive disease related to insulin resistance
• May be managed with just diet and exercise, or may
require oral medication and/or insulin injections
• Most commonly seen in overweight/obese people, but
can also develop in normal weight people
– Gestational Diabetes
• Diabetes that develops during pregnancy
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Nutrition for Diabetes
o Goal of nutrition therapy
– To help people with diabetes learn how to make
healthy food choices, which will optimize
glycemic control and prevent complications
– A healthy, well-balanced diet
– There is no one “diabetic diet”
• Healthy eating for diabetes includes whole grain
cereals, lean protein foods, fruits, generous portions
of non-starchy vegetables
• Ideally, a person with diabetes receives an
individualized meal plan from a nutritionist or
dietitian
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Nutrition for Diabetes
– Questions to ask patients:
• What are the food-related factors that increase
one’s chance of developing diabetes?
– Answer: Obesity (in part due to excess food
intake) is the only food-related cause of
diabetes. Eating too much sugar does not
cause diabetes.
• What are the factors that influence eating habits?
– There are many factors that influence food
choices and eating habits. Economic and
family situation, geography and cultural all
contribute to food choices.
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Nutrition for Diabetes
• Questions to ask patients:
– What types of foods do you normally eat?
• This allows identification of healthy vs. less healthy eating
patterns
– What types of foods do you eat after waking?
• Carbohydrate foods are less well-tolerated in the morning
hours during pregnancy
– Are you able to monitor your blood sugar?
• If patients have access to a glucometer and test strips,
monitoring post-meal blood sugars can be a useful tool in
assessing dietary factors
• Elevated post-meal blood sugars may indicate too much
carbohydrate is being consumed, or inadequate medication
or insulin is being provided
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Managing Type 2 Diabetes
o Glycemic Control
– Self-monitoring should only be considered
when the person with diabetes and their
health care team is prepared to learn the
skill, record the findings, understand the
data, and act appropriately on the data
– Desired plasma glucose levels are <6.0
mmol/l (<110 mg/dl) before meals, and <7.8
mmol/l (<140 mg/dl) 2 h after meals.
• Allow higher targets for patients on insulin or
sulfonylureas at risk for hypoglycemia
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Managing Type 2 Diabetes
o Provide dietary counseling that optimizes a
healthy weight and reduces cardiovascular risk
profile (e.g., low fat, low salt)
o Using the plate method is one way to instruct
lower-literacy patients on a healthy diabetes
meal plan
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The Plate Method
o Easy to teach
o Easy to understand
o Based on dividing portions
onto a standard 9” plate
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http://www.dlife.com/diabetes/information/inspiration_expert_advice/expert_columns/Pr
escriptionSolutionsPlatePlannerEnglish_LetterSize_3-09.pdf
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Cardiovascular Disease
o Caused by disease of the blood vessels
(atherosclerosis) of the heart, usually as part
of the process which affects blood vessels
more generally
o Stroke and heart disease are the main
cardiovascular diseases
– Stroke is the main cardiovascular disease in many
east Asian countries
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Nutrition for Cardiovascular Disease
o Eat a diet rich in fruits, vegetables and whole cereal
grains
– This provides potassium and fiber, both clearly
linked to reduced chronic disease risk
o Don’t add salt during food preparation
o Limit use of processed and pre-prepared food items
– They are typically very high in salt
o Cook with no or very minimal added fats and oils
– If fat or oil is used, unsaturated is healthiest option
(canola, olive, etc)
o Maintain a healthy body weight
o Control blood pressure and blood sugar
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Successful Long-term Weight Control
o Long-term behavioral treatment, whatever
form it takes, encourages patients to practice
four key behaviors
1. Exercise regularly
2. Consume a lower-calorie diet
3. Monitor weight regularly
4. Record food intake and physical activity
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Preventing Chronic Diseases
o Maintain a healthy body weight
– The WHO goals are
• For an adult median BMI of 21 to 23 kg/m2
• For individuals, the recommendation is to
maintain a BMI in the range 18.5 to 24.9 kg/m2
and to avoid a weight gain greater than 5 kg
(11 pounds) during adult life
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Preventing Chronic Diseases:
Physical Activity
o Stay physically active
– The WHO goal is for all people to get
one hour per day on most days of the
week of moderate-intensity activity,
such as brisk walking
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Preventing Chronic Diseases:
Breastfeeding
o Infants should be breastfed for at least 6 months
o Breastfeeding is convenient
– Food is readily available for the infant, and requires
no special preparation or equipment
o Provides the best balance and quantity of nutrients
ideal for the human infant
o Both colostrum and breastmilk have anti-infective
constituents that help limit infectious disease
o Bottle feeding increases risk of infections from
contamination with pathogenic organisms in the milk,
the formula and the water used in preparation, as well
as in bottles, teats (bottle nipples) and other items
used for infant feeding
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Preventing Chronic Disease:
Breastfeeding
o More economical than bottle-feeding
– Bottle feeding involves costs for infant formula
the bottles and teats and the fuel necessary for
bottle sterilization
o Prolongs the duration of post-partum anovulation,
helping mothers to space their children
o Enhances bonding and relationship between mother
and infant
o Seems to reduce the risk of allergies, obesity and
certain other health problems
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Preventing Chronic Diseases:
Summary Points
o Chronic diseases can be prevented with
lifestyle changes
– Lifestyle changes include healthier eating,
increasing physical activity, and smoking cessation
o Very active populations with diets rich in
vegetables, legumes, fruits and whole grains
may have a total fat intake of up to 35% of
total calories without the risk of unhealthy
weight gain. WHO, 2003
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Contact Information
Kathaleen Briggs Early, PhD, RD, CDE
kearly@pnwu.org