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Sound Bite Nutrition  --AAP 2013
 

Sound Bite Nutrition --AAP 2013

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  • Should BMI be used diagnostically?Mostly it is a screening tool
  • Reductionist approach may be part of the problem
  • Mean anthropometric measures in children 2-18 years of ageNHANES Data 1999-2004 –24 hour recall 32% children; 30% of adolescents reported candy consumption day of recallCandy consumers have lower weight lower BMI lower waist circumference than non consumers
  • Candy consumers (w/ lower weight, BMI, waist circ) eat more calories
  • Sweetened cereals 6-9 mo 14% 9-12 mo 19%12-15 mo 31%15-18 mo 45 %18-24 mo 35%
  • How does farm policy play out in the grocery store? Fresh fruits and vegetables cost more

Sound Bite Nutrition  --AAP 2013 Sound Bite Nutrition --AAP 2013 Presentation Transcript

  • SOUND BITE NUTRITION Navigating nutrition news and providing nutrition support for your patients and their families
  • Body size lies • Interpreting – Growth charts – Body weight – BMI
  • GROWTH CHARTS: Breast fed fast growers picked up on both charts 0 1 2 3 4 5 6 Series 1 Series 2 Series 3 CDC WHO
  • Growth Charts: Breastfed Babies CDC – boys 0-36 mos WHO – boys 0-24 mos 50 % 50 %
  • Body Weight •The scale cannot distinguish between lean body mass and body fat •Fitness trumps weight every time
  • BMI is a poor surrogate measure of adiposity • Compared w/ dual energy x-ray absorptiometry, excessive body fat was found in 77% of children w/ BMI > 95th % 20% of children w/ BMI between 85-94th % 50% of children -―moderate‖ adiposity 30% of children - ―normal‖ body fat stores Freedman, et al. Classification of Body Fatness by Body Mass Index–for-Age Categories Among Children Arch Pediatr Adolesc Med. 2009;163(9):805-811.
  • Body weight challenges in families Can we crack the code? • Obesity is related to environment – increasing ease of access to high-energy palatable food – diminishing requirement for physical activity • Obesity linked to genetics – 40-75% heritable – Severe defects in single genes impact appetite via central control mechanisms (gut, brain, adipose tissue) • Hunger • Satiety • Hedonic effects of food O’Rahilly & Farooqi. Human Obesity: A Heritable Neurobehavioral Disorder That is Highly Sensitive to Environmental Conditions Diabetes, Vol. 57, November 2008
  • Energy Balance is a Physiologically Controlled Process • PRO – a more enlightened attitude toward people with obesity with a consequent reduction in their experience of social and economic discrimination – greater opportunity to do good as we focus on individually targeted approaches to the treatment and prevention of obesity. promote health at every size
  • Energy Balance is a Physiologically Controlled Process • CON: Unpopular position – Challenges current notions of self determination, discipline and self regulation
  • Shift the focus away from body size • Focus on metabolic health • Spotlight true biomarkers of health and/or disease • Avoid risk distortion • Allow clinicians to effectively address behavior linked with unhealthy lifestyle • Minimizes stigma and shame
  • Disordered Eating • Not always a primary issue with body weight, body image • Common and novel antecedents – Sensory integration – Rigid thinking, fixed mind set (ASD, ADHD, Obs/Comp Disorders) – Insulin resistance – Other neurobiological disorders • ? MC4R deficiency • Early intervention is key B.Y. Modugno, Scan’s PULSE, vol. 28, No. 1. Winter, 2009.
  • Saturated fat, cholesterol and cardiovascular risk: What is the link? •Key 1953 data, (amended) •Studies did not discriminate between naturally occurring SFA and trans fat
  • Saturated fat, cholesterol and cardiovascular risk: What is the link? 2009 - Heart and Stroke Foundation of Canada -funding by Beef producers, dairy farmers of Canada Andrew Mente, Lawrence de Koning, Harry S. Shannon, Sonia S. Anand, MD, PhD, FRCPC. Arch Intern Med. 2009;169(7):659-669
  • The Association of Saturated Fat with Cardiovascular Disease Siri-Tarino, Sun, Hu, and Krauss. Am J Clin Nutr. 2010 March; 91(3): 535–546. “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”
  • If breast milk were packaged
  • Fig 2 Dose-response analyses of egg consumption and risk of coronary heart disease. Rong Y et al. BMJ 2013;346:bmj.e8539 ©2013 by British Medical Journal Publishing Group
  • Fat and Inflammation: What is the role of fatty acid balance? Fatty Acids SFA LCSF Palmitic Stearic Myristic MCFA Lauric SCFA Butyric Valeric MUFA Oleic Palmitoleic PUFA Omega 3 Omega 6 Omega 9
  • Fatty Acid Ratio in Foods • Western diets are deficient in omega-3 fatty acids w/ excessive amounts of omega-6 fatty acids1 • A lower ratio of omega-6/omega-3 fatty acids linked to reduced risk of many chronic diseases of high prevalence in Western societies1 • The optimal dose or ratio of omega-6/omega-3 varies from 1/1 to 4/1 2 1. A.P Simopoulos. Biomedicine & Pharmacotherapy. Volume 56, Issue 8, October 2002, Pages 365–379; 2. A.P. Simopoulos. Food Reviews International. Vol. 20, No. 1, pp. 77–90, 2004
  • Fatty Acid Ratio in Foods • Both omega-6 and omega- 3 fatty acids are healthy • The omega-3 to omega-6 ratio is basically the “good divided by the good,” so it is of no value in evaluating diet quality or predicting disease. Dr. Frank Sacks. Professor of Cardiovascular Disease Prevention, Department of Nutrition, Harvard School of Public Health.
  • •Fats in the conventional American diet •1909-1999 Am J Clin Nutr. 2011 May; 93(5): 950–962
  • Omega three intake •Fats in the conventional American diet •1909-1999 Am J Clin Nutr. 2011 May; 93(5): 950–962
  • ω 3, ω 6 Fatty Acids (mg) 0 500 1000 1500 2000 2500 3000 Salmon WC Farmed salmon Omega 6 Omega 3 0 5 10 15 20 25 30 35 40 45 Omega 6 Omega 3 MILK
  • Change in FA Content of Beef In CAFOs
  • Beef
  • Food Sources of ω 6, ω 3 Fatty Acids 0 0.5 1 1.5 2 2.5 Butter 1909 Butter T Butter C Linoleic FA (18:2) Alpha Linolenic FA (18:3) Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962 Modern Nutrition in Health and Disease, Ed 15. c 2006
  • Food Sources of ω 6, ω 3 Fatty Acids 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Pork 1909 Pork T Pork C Linoleic FA (18:2) Alpha Linolenic FA (18:3) Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962 Modern Nutrition in Health and Disease, Ed 15. c 2006
  • Food Sources of ω 6, ω 3 Fatty Acids 0 0.5 1 1.5 2 2.5 3 Chicken 1909 Chicken T Chicken C Linoleic FA (18:2) Alpha Linolenic FA (18:3) Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962 Modern Nutrition in Health and Disease, Ed 15. c 2006
  • Food Sources of ω 6, ω 3 Fatty Acids 0 0.2 0.4 0.6 0.8 1 1.2 1.4 Egg 1909 Egg T Egg C Linoleic FA (18:2) Alpha Linoleic FA (18:3) Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962 Modern Nutrition in Health and Disease, Ed 15. c 2006
  • Is eating more salmon (fish) the answer? •Cost •Wild Caught: $ 9.99-23.99/pound •Farmed salmon: $ 7.99-8.99/ pound •Sustainability •It generally takes three pounds of wild fish to grow one pound of farmed salmon •Most salmon farmed in ocean net pens get an "Avoid" ranking Health Alert •Environmental Defense Fund has issued a health advisory for farmed salmon due to high levels of PCBs. http://www.montereybayaquarium.org/cr/SeafoodWatch/web/sfw_factsheet .aspx?gid=49
  • Hooked: Sugar, sweets, & artificial sweeteners • Food is not ordinarily like a substance of abuse, but intermittent bingeing and deprivation changes that. • Sweet taste elicits release of dopamine in the nucleus acumbens • Whether or not it is a good idea to call this a “food addiction” in people is both a scientific and societal question that has yet to be answered Avena, Rada and Hoebel. Neurosci Biobehav Rev. 2008; 32(1): 20–39.
  • Candy Consumers (n = 3,458) vs. Non-Consumers (n=7,724) 0 10 20 30 40 50 60 70 80 Weight (kg) BMI Waist Circ. (cm) T. Candy -Cons T. Candy- NC Choc-Cons. Choc-NC Sugar-Cons Sugar-NC http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675
  • Candy Consumers (n = 3,458) vs. Non-Consumers (n=7,724) 1800 1900 2000 2100 2200 2300 2400 Calories T. Candy -Cons T. Candy- NC Choc-Cons. Choc-NC Sugar-Cons Sugar-NC http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675
  • Factors Influencing a Sweet Tooth • Biochemical – Glucose tolerance – Hyperinsulinemia – Insulin resistance – Leptin resistance • Microbial • Neurological/Behavioral – Dopamine – Serotonin • Sensory – Mouthfeel – Texture • Behavioral – Token economy • Familial • Economic – Subsidized food supply • Environmental
  • Containing a Sweet Tooth • Balanced meals – Adequate protein – Emphasize whole plant foods with rich fiber content – Enough healthy fats • Plan for treats – Discreet, intermittent • Emphasis on assessing hunger & satiety • Cultivate effective self regulation, resilience
  • The Salt Debate http://www.oxfordjournals.org/our_journals/ajh/iom_sodium_report_comment aries.html • Oct 2013 Am Journal of Hypertension—6 articles • Experts are unclear exactly how much sodium is ideal for good health. • There is likely a middle ground, but the amount cannot yet be pinpointed.
  • The Salt Debate Where do you begin?  Purchase more whole foods  More fresh/frozen produce  Less prepared foods  Modest refined starch, sugars  Salt for full flavor, not salty  Choose carefully when eating away from home Mattes, RD, Donnelly, D. Relative contributions of dietary sodium sources. Journal of the American College of Nutrition. 1991 Aug;10(4):383-393.
  • What are we buying in the supermarket?
  • Saving the planet: Meatless Mondays, vegetarian and vegan diets Polyface Farms, Swoopes, VA
  • Saving the planet: Meatless Mondays, vegetarian and vegan diets • Biodynamic farming drives a rich soil ecology • Plants take nutrients from the soil; Animal manure combined with composted plant matter contribute needed nutrients • Waste in the conventional model is considered a resource in the bio-dynamic model. http://muchmorethanfood.com/?s=poly face+farm Polyface Farm relies on hay feed for a mere 40 days of the year
  • Paleo and High Protein diets What's the harm?
  • What else may be problematic in highly processed food? • The liver is the primary metabolic clearinghouse for 4 specific foodstuffs that have been associated with the development of metabolic syndrome – trans-fats – branched-chain amino acids – ethanol – fructose Bremer, Mietus-Snyder , & Lustig. Pediatrics. 2012 March; 129(3): 557– 570.
  • Paleo and High Protein diets What's the harm? Circulating concentrations of branched-chain amino acids (BCAAs) can affect carbohydrate metabolism in skeletal muscle, and therefore may alter insulin sensitivity Newgard, et al. A Branched-Chain Amino Acid-Related Metabolic Signature that Differentiates Obese and Lean Humans and Contributes to Insulin Resistance. Cell Metabolism, 9. 311-326. April 8, 2009.
  • Amino Acids Comparison (mg per 100 calories) 0 50 100 150 200 250 300 Human milk Enfamil NB Enfamil PI Isomil*
  • Getting kids to eat: How to feed super tasters and picky eaters • Food preferences are shaped by a combination of genetic and environmental factors • Over-control, restriction, pressure to eat, and a promise of rewards have negative effects on children's food acceptance • Children model themselves on their parents’ eating behaviors, lifestyles, eating-related attitudes, and dissatisfaction regarding body image
  • NEOPHOBIA Genetic Traits Environmental Factors Behavioral Factors Parents Siblings •In utero •Breastfeeding •Exposure •Modeling Anxiety Emotionality British Journal of Nutrition (2008), 99, Suppl. 1, S15–S21
  • Consumption patterns of infants and toddlers consuming foods at least once a day 0 10 20 30 40 50 60 70 6-8.9 mo 9-11.9 mo 12-14.9 mo 15-17.9 mo 18-24 mo Feeding Infants and Toddlers Study (FITS) ADAJ 2010
  • NEOPHOBIA
  • Supertasters • 25 % of population (35% women; 15% men) – 25% non tasters – 50% medium tasters • Far more sensitive to odors, flavors of food • Other characteristics may also be more intensely experiences – Texture – Temperature – Color – Mouth feel – Size, shape HYPOSENSITIVE HYPERSENSITIVE
  • Incidence of Food Allergies in the US Amy M. Branum and Susan L. Lukacs , Pedriatrics. Food Allergy Among Children in the United States. Nov 16, 2009 DOI: 10.1542/peds.2009-1210
  • Grains, gluten free and gut health: Why so many food sensitivities today? • Basic dietary sources – Barley (malt, malt flavoring and malt vinegar are usually made from barley) – Rye – Triticale (a cross between wheat and rye) – Wheat
  • Grains, gluten free and gut health: Typical food sources of gluten Beer Breads Cakes & pies Candies Cereals Cookies and crackers Croutons French fries Gravies Imitation meat or seafood Matzo Pastas Processed luncheon meats Salad dressings Sauces, including soy sauce Self-basting poultry Soups and soup bases Dry roasted & honey roasted nuts and seeds Vegetables in sauce Seasoned rice mixes Seasoned snack foods, such as potato & tortilla chips
  • Grains, gluten free and gut health: 300 million pounds of gluten added to processed food per year MSG Smoke flavors Glazes Textured vegetable protein Artificial flavors Ice cream, frozen yogurt Hydrolyzed vegetable protein Natural colors Instant teas, coffees Hydrogenated starch hydrozylate Artificial colors Mayonnaise Hydroxypropylated starch Caramel coloring & flavoring Mustard Pregelatinized starch Soy sauce Frying oil Vegetable gum Miso Seasoned poultry/meat Vegetable protein Boullion or stock cubes Sour cream Extenders and binders Cheese foods/spreads Dry & honey roasted nuts Maltodextrin Dextrin Maltose Baking powder Natural flavors Chocolate
  • Autism spectrum disorders, ADHD, and related conditions: How diet can make a difference • EATING FOR AUTISM—Elizabeth Strickland, MS, RD • Step 1: Transition Your Child to a Healthy Diet • Step 2: Make Sure Your Child is Getting Enough Basic Nutrients
  • Autism spectrum disorders, ADHD, and related conditions: How diet can make a difference Step 3: Choose a Daily Multivitamin and Mineral Supplement for Your Child Step 4: Increase Your Child’s Omega-3 Fatty Acid Intake Step 5: Resolve Your Child’s Feeding Problem Step 6: Heal Your Child’s Gut Step 7: Identify and Treat Food Allergies Step 8: Consider Putting Your Child on a Special Elimination Diet Step 9: Try High Dose Vitamin B6 with Magnesium Step 10: Explore Additional Supplements
  • Body Burden: reducing chemical contamination especially in utero and for young children
  • Food System–Related Environmental Chemicals Detectable In Pregnant Women In The United States, 2003–04. Sutton P et al. Health Aff 2011;30:888-897 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
  • Body Burden: reducing chemical contamination especially in utero and for young children J Clin Endocrinol Metab. 2011 Mar;96(3):E480-4. doi: 10.1210/jc.2010-1658. Epub 2010 Dec 30.
  • Body Burden: reducing chemical contamination especially in utero and for young children http://www.epa.gov/oppfead1/Publications/pest-impact-hsstaff.pdf
  • The Cost of Buying Conventional vs. Organic Foods Using a Sample Market Basket $0.00 $20.00 $40.00 $60.00 $80.00 $100.00 $120.00 $140.00 Market Basket Cost Conv-Ralph's Conv-WF Org WF
  • USDA Food Costs for Feeding Children Allocated by Individual Food Groups 2013 FOOD Δ USDA Guidelines % Costs 2-3 y/o % Costs 4-5 y/o % Costs 6-8 y/o Grain <13> 5 8 8 Vegetables 52 24 15 19 Fruit 57 17 37 32 Milk/ Milk Products 54 43 30 29 Meat and Beans <49> 6 7 9 Other (fats, sweets) <54> 5 3 3
  • The cost of food
  • How Much Does 100 Calories Cost? 0 10 20 30 40 50 60 70 80 90 100 Calories Soda Bread Potato chips Cookies Licorice Orange Apple Carrots 0 0.5 1 1.5 2 2.5 100 Calories Organic Milk Organic Apple GF Beef WC Salmon Cost in cents Cost in $$