CHAPTER 11 NUTRITION AND CHRONIC DISEASES

Chapter 11
Nutrition and Chronic
Diseases
Sizer and Whitney, Nutrition: Concepts and Controversies, 15th
Edition. © 2020 Cengage. All Rights Reserved. May not be
scanned, copied or duplicated, or posted to a publicly accessible
website, in whole or in part.

Sizer and Whitney, Nutrition: Concepts and Controversies, 15th Edition. © 2020 Cengage. All Rights Reserved.
May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Learning Objectives
• Discuss the relationship between risk factors and chronic
diseases
• Describe cardiovascular disease and identify its risk
factors
• Summarize the causes, consequences, and
management of type 2 diabetes
• Describe the relationships between diet and cancer
• Outline strategies for including sufficient fruit and
vegetables in a diet
• Describe the emerging science of nutritional genomics

Introduction
• Two types of diseases
• Infectious and chronic
• Nutrients and our body’s defenses
• Natural immunity
• Preventive measures provided by public health services
• Vaccines and sanitation
• Leading causes of death
• Cardiovascular diseases
• Diabetes
• Cancer

Figure 11.1: The Ten Leading Causes of
Death in the United Statesa
aRates are age adjusted to allow relative comparisons of mortality among groups and over time.
bAlcohol increases the risks for some cancers and strokes.
cMotor vehicle and other accidents are the leading cause of death among people aged 15–24, followed by homicide, suicide, cancer,
and heart disease. Alcohol contributes to about half of all accident fatalities.
Source: Data from National Center for Health Statistics: K. D. Kochanek, and coauthors, Deaths: Final data for 2014, National Vital
Statistics Reports 65, 4 (2016): 1–122.

The Concept of Risk Factors (Slide 1 of 2)
• Risk factors are correlated with diseases
• Traits, conditions, or lifestyle habits that increase people’s chances
of developing diseases
• Infectious diseases have a single cause
• Exposure to a specific pathogen

The Concept of Risk Factors (Slide 2 of 2)
• The chronic diseases have many risk factors in common
• Excessive alcohol intake
• Lack of physical activity
• Smoking or tobacco use
• Diet

Table 11.1: Chronic Disease Risk Factorsa (Slide 1 of 3)
Risk
Factors/Diseases
Atherosclerosis Hypertension Diabetes,
Type 2
Cancers Obesity
Advancing age
(unmodifiable)
x x x x N A
Family history, or
heredity
(unmodifiable)
x x x x x
Atherosclerosisb N A x N A N A N A
Diabetesb x x N A N A N A
Hypertensionb x N A N A N A N A
Obesityb x x x x N A
High blood L D L
and triglycerides;
low H D L
x N A N A N A N A

Risk
Factors/Diseases
Atherosclerosis Hypertens
ion
Diabetes,
Type 2
Cancers Obesity
Excessive alcohol
intake
N A x N A x x
Physical inactivity x x x x x
Smoking/tobacco use x x N A x N A
Diet high in added
sugars
N A N A N A N A x
Atherogenic diet
(high in saturated
and/or trans fat and
low in vegetables,
fruit, and whole
grainsc
x x N A x x

Risk
Factors/Diseases
Atherosclerosis Hypertension Diabetes,
Type 2
Cancers Obesity
Diet high in
salty/pickled foods
N A x N A x N A
Diet low in
vitamins and/or
minerals
x x N A x N A
aEnvironmental factors such as contamination are not included in this table.
bNote that atherosclerosis, diabetes, hypertension, and obesity are shown both as risk factors and as diseases in their own right.
cAn atherogenic diet produces high blood L D L and V L D L and low blood H D L. Such a diet is a C V D risk factor, and these blood-lipid test
results, themselves, are also considered risk factors (see Table 11-3, p. 410).

Figure 11.2: Interrelationships among
Chronic Diseases

Cardiovascular Diseases (C V D)
• Disease of the heart and blood vessels
• Leading cause of death in the United States
• Examples: Hypertension, coronary heart disease, and
stroke

Atherosclerosis (Slide 1 of 3)
• Hardening of the arteries
• No one is completely free of all signs of atherosclerosis
• Question is how far it has advanced and what can be done to slow
or reverse it
• Hypertension and atherosclerosis are interrelated and
accelerate each other
• As most people age, atherosclerosis progresses steadily

Figure 11.3: The Formation of Plaques in
Atherosclerosis

• The development of
atherosclerosis involves:
• Plaque development
• Blood clot formation
• Hypertension
• Blood clots
• Thrombus: Stationary clot
• The tissue death caused is called
thrombosis
• Embolus: A clot broken loose
• Embolism: Clot remains stuck in a
narrow artery
SPL/Science Source

• When an artery is blocked, it may swell and burst,
causing an aneurysm
• Hemorrhage: Blood leaks rapidly when a blood vessel
bursts
• Atherosclerosis raises blood pressure
• High blood pressure accelerates atherosclerosis

Risk Factors for C V D (Slide 1 of 2)
• Nonmodifiable risk factors
• Increasing age
• Male gender
• Family history (heredity)
• Modifiable risk factors
• High blood L D L cholesterol
• Low blood H D L cholesterol
• High blood triglyceride (V L D
L) levels
• High blood pressure
(hypertension)
• Diabetes
© Iofoto/Shutterstock.com

Risk Factors for C V D (Slide 2 of 2)
• Obesity
• Especially central obesity
• Physical inactivity
• Cigarette smoking and excessive alcohol consumption
• High intake of sodium
• An atherogenic diet
• High in saturated fats and trans fats and low in vegetables, fruit, and
whole grains

Metabolic Syndrome
• Metabolic syndrome includes any three or more of the
following:
• High fasting blood glucose
• Central obesity
• Hypertension
• Low blood high-density lipoprotein (H D L)
• High blood triglycerides

Figure 11.5: Adult Standards for Blood
Lipids
Category Total blood
cholesterol
(milligrams/
deciliter)
L D L
cholesterol
(milligrams/deciliter)
H D L
cholesterol
(milligrams/deciliter)
Triglycerides,
fasting
(milligrams/
deciliter)
Healthy <200 <100a ≥60 <150
Borderline 200–239 130–159b 59–40 150–199
Unhealthy ≥240 160–189c <40 200–499d
a100–129 milligrams/deciliter of L D L indicates a near optimal level.
bL D L cholesterol-lowering medication may be needed at 130 milligrams/deciliter, depending on other risks.
c>190 milligrams/deciliter of L D L indicates a very high risk.
d>500 milligrams/deciliter of triglycerides indicates a very high risk.

Figure 11.8: The American Heart
Association’s Heart Attack Risk Calculator
American Heart Association

Think Fitness: Ways to Include Physical
Activity in a Day (Slide 1 of 2)
• Benefits of physical activity
• Coach a sport
• Garden
• Hike, bike, or walk to nearby stores or to classes
• Mow, trim, and rake by hand
• Park a block from your destination and walk
• Play a sport
• Play with children
• Take classes for credit in dancing, sports, conditioning, or
swimming
• Take the stairs, not the elevator

Think Fitness: Ways to Include Physical
Activity in a Day (Slide 2 of 2)
• Walk a dog
• Walk every day
• Wash your car with extra vigor, or bend and stretch to wash your
toes in the bath
• Work out at a fitness club
• Work out with friends to help one another stay fit
• Give away two labor-saving devices to someone who needs them
• Lift small hand weights while talking on the phone, reading e-mail,
or watching TV
• Stretch often during the day

Recommendations for Reducing C V D
Risk (Slide 1 of 3)
• Estimate heart disease risk
• Lifestyle changes
• Increase physical activity
• Lose weight if overweight
• Implement dietary changes
• Treat diseases you already have
• Reduce exposure to tobacco smoke
• Control alcohol intake
• Learn your family history
• Know your blood pressure

Risk (Slide 2 of 3)
• Recognize a heart attack
• Pain or discomfort in the jaw, neck, or back
• Feeling weak, light-headed, or faint
• Chest pain or discomfort
• Pain or discomfort in arms or shoulders
• Shortness of breath
• Recognize your salt/sodium intake
• Increase potassium intake

Risk (Slide 3 of 3)
• Diet to reduce C V D risk
• Reduce fat intake
• Saturated and trans fats
• Limit refined starches and added sugars
• Eat fruits, vegetables, and whole grains
• Eat foods rich in omega-3 fatty acids
• Nutrient supplements, drugs, herbal remedies
• Manage lifestyle changes

Table 11.5: How Much Does Changing the
Eating Pattern Lower L D L Cholesterol?
Diet-Related Component Modification Possible L D L
Reduction
Saturated fat <7% of calories 8–10%
Weight reduction (if overweight) Lose 10 pounds 5–8%
Soluble, viscous fiber 5–10 grams/day 3–5%

Diabetes (Slide 1 of 2)
• Well over one-third of U.S. adults have prediabetes
• Exhibiting warning signs of diabetes to come
• Two common forms of diabetes
• Type 1
• Type 2
• Type 1 diabetes accounts for 5 to 10 percent of all cases
• Sets in during childhood or adolescence but it can begin at any
age, even late in life
• Increasing in prevalence by about 3 percent each year
• Autoimmune disorder

Diabetes (Slide 2 of 2)
• Type 2 diabetes is responsible for 90 to 95 percent of
cases in both adults and children
• Predominant type closely linked with obesity
• Been on the rise among children and adolescents
• Insulin resistance: An inadequate response of the body’s cells to
the hormone insulin

How Does Type 2 Diabetes Develop?
(Slide 1 of 2)
• Insulin resistance causes glucose and insulin to build up
in the bloodstream
• The blood glucose concentration rises
• The overtaxed cells of the pancreas begin to fail and
reduce their insulin output, while blood glucose soars
farther out of control

How Does Type 2 Diabetes Develop?
(Slide 2 of 2)
• Symptoms
• Intense hunger
• Frequent urination
• Intense thirst
• Recognizing the symptoms of diabetes and seeking
treatment are important steps for protecting health

Harms from Diabetes
• Atherosclerosis tends to develop early, progress rapidly,
and become severe in people with diabetes
• Risk factors for type 2 diabetes are:
• Advancing age
• Overweight and obesity
• Impaired kidney, eye, and nerve function
• Diminished blood circulation and nerve function
• Tendency to develop slow-healing injuries and infections
• Reduced blood flow to the kidneys damages them
• Poor circulation to the eyes impairs vision and leads to blindness

Diabetes Prevention and Management
(Slide 1 of 2)
• Know your family history
• Diagnosis can be made using any of
several tests
• Fasting plasma glucose test
• Nonfasting A 1 C test
• Lose weight if overweight
• Be physically active
• Choose your diet with care
• Control carbohydrate intake
Anna Kucherova/Shutterstock.com

Diabetes Prevention and Management
(Slide 2 of 2)
• Reduce saturated fat intake to less than 10 percent of
calories and limit trans fat as much as possible
• Protein intake should be individualized
• Alcohol intake should be moderate
• Pay strict attention to the Dietary Guidelines for
Americans, particularly concerning intakes of nutrient-
dense foods, sodium, saturated fats, and added sugars

Cancer
• Second leading cause of disability and death in the
United States
• Prevention of cancer is preferable to potential for cure
• Risk factors
• Lifestyle factors
• Environmental exposures
• Diet
• Dietary components
• Overeating

The Cancer Disease Process (Slide 1 of 2)
• Cancer arises in the genetic material inside a person’s
cells
• The process is called carcinogenesis
• Begins when a cell’s genetic material sustains damage
from a carcinogen
• Radiation, a free radical, or another cancer-causing chemical
• Damage occurs everyday and is repaired by the cell
• On failure to repair itself, the cell dies by cellular suicide,
preventing its progeny to inherit faulty genes

The Cancer Disease Process (Slide 2 of 2)
• When a damaged cell doesn't die, the immune system
destroys such cells
• When the immune system falters, a tumor is formed
• Life-threatening cancer begins with an event called
initiation
• Promoters stimulate tumor growth

Figure 11.10: Risk-Benefit Relationships

Figure 11.11: Cancer Development

Cancer Risk Factors (Slide 1 of 2)
• Advancing age
• Chronic inflammation
• Diet
• Weakened immunity
• Infections
• Obesity and estrogen
• Alcohol with smoking
• Fats and fatty acids

Cancer Risk Factors (Slide 2 of 2)
• Carcinogens in red and processed meats
• Cooking methods
• Iron
• Fried foods
• Environmental factors
• Overexposure to the sun and exposure to radiation

Cancer Prevention (Slide 1 of 2)
• A key to evaluating the safety of foods
is the frequency of consumption
• Balanced and varied diet must be
followed
• Evidence continues to accumulate in
favor of fiber-rich foods
• Whole foods and phytochemicals
reduce oxidative damage to cell
structures
• Some phytochemicals are thought to act as
anticarcinogens
Shulevskyy Volodymyr/Shutterstock.com
Lisa S./Shutterstock.com

Cancer Prevention (Slide 2 of 2)
• Supplements of vitamins and nutrients have not been
proved to prevent cancer
• Use alcohol sparingly or abstain from use
• Achieve and maintain a healthy body weight throughout
life
• Engage in regular physical activity
• Whenever people’s food intakes are limited, the onset of
cancer is delayed
• Known as the caloric effect

Steps to Minimize Carcinogen Formation
during Cooking
• Marinate meats before cooking, and roast or bake them
in the oven
• When grilling, line the grill with foil, or wrap the food in foil
• Take care not to burn foods
• Limit intakes of crispy, browned French fries and chips
and other well-browned foods

Table 11.9: Recommendations and Strategies
for Reducing Cancer Risk (Slide 1 of 3)
Recommendations Strategies
Body fatness. Achieve and
maintain a healthy body weight
throughout life
• Follow the Healthy U.S.-Style Eating Pattern for
your appropriate energy level
• Engage in regular physical activity
• Limit consumption of energy-dense foods and
avoid beverages with added sugars
• Consume “fast foods” sparingly, if at all
Physical activity. Adopt a
physically active lifestyle
• Engage in at least 150 minutes of moderate-
intensity physical activity or 75 minutes of
vigorous-intensity physical activity or an
equivalent combination throughout the week
• Limit sedentary behaviors such as sitting, lying
down, watching television, and other forms of
screen-based recreation

Plant-based foods. Consume a
healthy diet with an emphasis
on whole foods from plants
• Eat at least the daily amounts of vegetables
and fruit recommended by the U S D A Eating
Patterns
• Choose whole grains instead of refined grain
products
• Limit intake of red meat and avoid processed
meats
• Limit refined starchy foods
Alcoholic drinks. If you drink
alcoholic beverages, limit
consumption
• Drink no more than two drinks a day for men
and one drink a day for women

Preservation, processing,
preparation.
Limit consumption of salt-cured
foods and processed meats
• Avoid salt-preserved, salted, or salty foods
• Limit consumption of processed foods with
added salt to ensure an intake of less than 6
grams of salt (2.4 grams of sodium) a day
• Avoid processed meats
Dietary supplements. Aim to
meet nutritional needs through
diet
• Dietary supplements are not recommended for
cancer prevention
Sources: L. H. Kushi and coauthors, American Cancer Society guidelines on nutrition and physical activity for cancer prevention, CA:
Cancer Journal for Clinicians 62 (2012): 30–67; World Cancer Research Fund/American Institute for Cancer Research, Food,
Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective (Washington, D.C.: AICR, 2007), pp. 373–390.

Deciding about C A M (Slide 1 of 2)
• Stands for complementary and alternative medicine
• A group of diverse medical and health care systems,
practices, and products that are not considered to be a
part of conventional medicine
• C A M best bets are:
• Herbal medicines
• Acupuncture

Deciding about C A M (Slide 2 of 2)
• A C A M worst case
• Use of the drug laetrile, a C A M treatment for cancer, which was a
hazardous choice because of its high cyanide content
• A curious case of anosmia, a loss of the sense of smell,
occurred due to zinc gel being squirted into the nose
• C A M products are not tested for safety
• Other issues with C A M
• Mislabeled herbs
• Lack of knowledge

The D A S H Diet: Preventive Medicine
• People who consume the adequate, balanced, calorie-
controlled, moderate, and varied diet recommended by
the Dietary Guidelines for Americans enjoy a longer,
healthier life than those who do not
• To lower saturated fat intakes, the Dietary Approaches to
Stop Hypertension (D A S H) diet emphasizes fruit,
vegetables, whole grains, and fat-free or low-fat milk and
milk products

Figure 11.13: Proper Nutrition Shields
against Diseases

Controversy 11 - Nutritional Genomics:
Can It Deliver on Its Promises? (Slide 1 of 2)
• Genomics: The study of all the genes in an organism
and their interactions with environmental factors
• Genome: The full complement of genetic material in the
chromosomes of a cell
• Once a disease-associated variant is observed in the
genetic profile, the health care provider can employ
lifestyle choices and treatment options to minimize the
potential for harm

Controversy 11 - Nutritional Genomics:
Can It Deliver on Its Promises? (Slide 2 of 2)
• Genes influence nutrition and disease
• Small variations in D N A sequences, called mutations, dictate
many of the differences among human beings
• The most common mutations are single nucleotide
polymorphisms (S N Ps)

Figure C11.1: Nutritional Genomics

Epigenetics (Slide 1 of 2)
• Epigenome
• Proteins and other molecules associated with chromosomes that
affect the expression of genes
• Turning genes “on” and “off”
• Inherited or altered
• Plays a role in cell differentiation
• Regulation includes the workings of large globular proteins
• Histones
• Methyl groups
• Future generation effects
• Embryonic development

Epigenetics (Slide 2 of 2)
• Modifying your epigenome
• Health implications
• Bioactive constituents in whole foods

Figure C11.2: Two Epigenetic Factors and
Gene Activity

Figure C11.3: An Epigenome Timeline

Arguments Surrounding Genetic Testing
(Slide 1 of 2)
• For nutritional genomics to be of practical value, people
must undergo genetic testing
• Helps detect gene variations that affect nutrition or nutrition-related
diseases
• For a few hundred dollars, consumers can easily order D
N A tests for themselves over the Internet
• Questions on whether testing translates into better health or
whether it is a waste of health care dollars

Arguments Surrounding Genetic Testing
(Slide 2 of 2)
• Even when D N A tests are
legitimate, interpreting the results is
complex
• Without the will to improve health
behaviors, it is unlikely that
personal genetic testing alone can
improve the health of the
population in the future
© Jirtie and Waterland

CHAPTER 11 NUTRITION AND CHRONIC DISEASES

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