NUTRITION POTPOURRI: FADS AND HOT TOPICS

Transcription

1 NUTRITION POTPOURRI: FADS AND HOT TOPICS AMY LOCKE, MD, FAAFP ASSOCIATE PROFESSOR CO-DIRECTOR, RESILIENCY CENTER UNIVERSITY OF UTAH UNIVERSITY OF UTAH HEALTH, 2017

2 THE PROBLEM Most don t meet dietary recommendations 1 Diet is the single most significant RF for disability and premature death 2 Nutrition minimally addressed in care 2 Much of what presented as fact is myth 3 1. USDA Devries et al. Amer J of Med Lesser et al. Am Fam Phys 2015

3 INFORMATION OVERLOAD!

4 MARKETING FOOD AS HEALTHY Granola Yogurt Juice Low Fat Cholesterol Free Heart Healthy

5 OVERVIEW Approaches to a healthy diet Dietary patterns Nutrients vs. foods Diets and weight loss Helping people make lifestyle change

6 Dietary Patterns PUTTING IT ALL TOGETHER

7 AES POLLING QUESTION What is the most important dietary change for weight loss? A. Monitor calories B. Low fat C. High fat D. Low carbohydrate E. No one diet has proven superior

8 MEDITERRANEAN DIET Emphasis on fruits and vegetables Plant proteins and fish over other animal proteins Whole grains (coarsely ground) Low glycemic index Healthy fats High omega-3 and monounsaturated fats Low omega-6 and saturated fats

9 1. de Lorgeril et al. Circulation Esposito et al JAMA Esposito et al. Endocrine 2016 MEDITERRANEAN DIET Lyon Diet Heart Study Secondary prevention of CVD 70% reduction in CV death 60% reduction of all cause mortality Compared to old AHA diet in Metabolic Syndrome 1 Higher resolution of metabolic syndrome 55% vs. 23% Decreased rates of diabetes 2

10 1. Trichopoulou et al NEJM Toledo et al. JAMA Int Med Byberg et al. Bon Miner Res 2016 MEDITERRANEAN DIET Lower overall mortality 1 The greater the adherence, the stronger the effect Reduced coronary artery disease and cancer deaths Decreased risk of breast cancer 2 Predimed Study: 70% risk reduction in group with Mediterranean diet with added olive oil Decreased hip fracture 3

11 DASH DIET Dietary Approaches to Stop Hypertension Improved cardiovascular risk factors 1-3 Decreased blood pressure Weight loss Managing and preventing diabetes 1. Siervo et al. Br. J Nutr Saneei et al. NMCD Shirani et al. Nutrition

12 1. Pan, A. et al. Arch Intern Med Bernstein et al. Circulation Farvid et al In J Cancer Appel, L. J. et al. JAMA 2005 PLANT BASED DIETS Reduced mortality 1 Decreased CAD 2 Decreased premenopausal breast cancer risk 3 Decreased blood pressure, lipids 4

13

14

15 NUTRITION SUMMARY Lots of vegetables and fruits Whole grains Low glycemic load Lean protein, emphasize plants Healthy fats Avoid sugary beverages and processed foods Limit saturated fat and trans fat Appropriate quantity of foods Moderate alcohol

16 1.DiMegilo and Mattes Int J Obes Relat Metab Disord Zheng et al. J Hum Nutr Diet 2015 BEVERAGES Satiety response diminished 1 Liquid calories more closely associated with obesity 2 Potential for large number of calories Often high glycemic index Water preferable NutritionSource.org

17

18 1 Ferreira-Pego et al J Nutr Imamura et al. Br J Sports Med Huang et al. Am J Clin Nutr 2017 ARTIFICIAL SWEETENERS Increased metabolic syndrome risk when consume > 5 beverages/week 1 Associated with increased DM 2 Increased by 21% with > 2 beverages/day 3 Substituting 1 serving/day with water decreases risk by 5% 3 Some evidence to suggest that individuals eat more when consume sweeteners without calories

19 MODERATE ALCOHOL CONSUMPTION Reduction in CVD 1 Increased breast cancer risk 2 May be mitigated by adequate dietary folate 3 May be less beneficial outside of white race 4 Newer studies bringing benefits into question 5 Don t recommend start drinking if nondrinker 1. Rimm et al BMJ Chen et al. Ann Intern Med Zhang et al. JAMA Jackson et al. Am J Public Health Knott et al. BMJ 2015

20 DIETS AND WEIGHT LOSS

21 AES POLLING QUESTION Which of the following has been shown to decrease success of weight loss? A. Physician s BMI B. Focus on food quality instead of calories C. Focus on high fat/low carb diets D. Focus on diet over exercise

22 BARRIERS TO PROVIDING ADVICE Time Priorities for the visit Expertise/Feelings of inadequacy Perception of efficacy Lack of referral options Stigma/negative physician attitudes

23 DEVELOPING A CUSTOMIZED PLAN Detailed History Review the options Realistic shortand long-term goals Engage team Reassess

24 LIFESTYLE HISTORY Nutrition: Physical Activity: Sleep: Stress: Social Connection: Screen time:

25 QUICK NUTRITION HISTORY Fruits and veggies Eating out Beverages Snacks 24 hr food recall Happy with food eaten? Cooking skills Time and money constraints

26 POPULAR DIETS Gluten free FODMAPS Ketogenic Intermittent fasting Paleo Whole30

27 Global Barriers and Opportunities for Governmental Healthy Eating Afshin et al Agriculture, industry, market Community Environment Scociocultural Individual

28 BARRIERS: NUTRITION Food knowledge Cooking skill Food prep interest Taste preference Family expectations Recognition of satiety Mindless eating Ability to read food labels Financial/food availability Time management Hours worked Child care Other activities (i.e. TV) Emotional eating

29 Setting the stage ADDITIONAL CONSIDERATIONS

30 SATIETY AND INTUITIVE EATING Associated with lower BMI 1,2 and better psychological health 1 Caloric density not related to satiety Identify emotional eating patterns 1. Van Dyke and Drinkwater, Public Health Nutr Cole et al. Mil Med 2016

31 MINDLESS EATING: BRIAN WANSINK Many things effect what we eat: Labels, surroundings, plate size, meal companions, proximity to food, variety of choices Decreased portion, package and tableware size lead to decreased consumption 1 1. Hollands et al. Cochrane Database Syst Rev 2015

32 THE SKILL OF COOKING Cooking classes Community Online Chop Chop Magazine Community Partnerships Dietetics programs Grocery stores Culinary schools Culinary Medicine

33 BUILDING THE TEAM The office The health system The community The country

34 THE OFFICE TEAM Physician APRN/PA Nurse Medical Assistants Pharmacist Dietitian Social Work Psychology Health Coach

35 MAKING RECOMMENDATIONS

36 TAILORING THE MESSAGE Fruits and veggies Healthy fats Cut back on fast food Limit sweet beverages

37 SOLUTIONS Meet patients where they are Motivators? Goals? Simple messages Focus on what to eat (less on what not to eat) Set a good example Write a prescription

38 RESOURCES FOR CONSUMERS Harvard School of Public Health Ending the Food Fight, David Ludwig Mindless Eating: Why We Eat More Than We Think, Brian Wansink; Oldways, cultural food resource, The Hunger Within, Marilyn Migliore Many apps and websites My fitness pal, sparkpeople, etc.