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Nutrition for Disease Prevention

Signature Assignment
Kim Phillips
PPE 310: Health Literacy for Schools
April 10 , 2016
Dr. Lineberry

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Introduction
Research using systems-based approaches has enabled us to understand that nutrition
plays an important role in a complex system which can influence the risk of certain diseases
(Bennett, Hall, Hu, McCartney, & Roberto, 2015). In the process of educating students in the
understanding of the importance of good nutrition for prevention of disease, it is necessary for
students to understand nutrition as well as disease. Since students have the greatest opportunity
to learn about the importance of good nutrition and healthy lifestyles in childhood and how these
factors contribute to long term disease prevention during their school day, it is essential for
schools to incorporate these topics into the curriculum. In order for this learning to have a full
and lasting effect, schools need to get families and the community involved in education and
implementation. Students not only need to learn about nutrition and healthy lifestyles, but need
to have real-life experience with everyday healthy decision making at school and determine why
it is important to start in childhood. Food Smart is a program described in the following
paragraphs that can be implemented in schools to fulfill these objectives. Students need to
understand the impact this will have on their present life as well as their future. If schools,
families, and communities work together to reach this goal, the benefit will be healthier choices
in schools, and a healthier generation with fewer diseases.

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Review of Current Literature

Among the top seven leading causes of death in the United States are heart disease,
cancer, and diabetes, with heart disease still being the leading cause of death (Nichols, 2015).
The risk for these three diseases can be dramatically reduced by nutrition (Nichols, 2015). Over
the past 50 to 60 years there has been a 50% decline in the mortality rates caused by
cardiovascular disease (Gidding, et al., 2009). It has been estimated that preventative measures
have contributed to over half of this decline (Gidding, et al., 2009). Nutrition is the cornerstone
to preventing heart disease especially early in life (Gidding, et al., 2009). According to Gidding
et al. (2009), developing a heart-healthy nutrition pattern at a young age can offer the great
benefits of reducing the development of obesity and establishing lifelong dietary habits (p. 1161).
Current American Heart Association recommendation which also coincide with the Dietary
Guidelines for Americans, stresses maintaining a healthy body weight, regular physical exercise,
and consuming a diet rich in vegetables and fruits, whole grains, low-fat and nonfat dairy
products, legumes, fish, and lean meat, coupled with food choices that minimize intakes of
excess energy, saturated fat, trans fat, cholesterol, and salt (Gidding et al, 2009, p. 1161). The
purpose of the report written by Gidding et al. is to suggest new approaches to implementing a
healthy diet within the context of current eating patterns (2009). With more Americans eating
outside the home,

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it is critical to educated children how to make healthier choices in order to benefit their long term
health in the prevention of certain diseases. The influences that are necessary for implementing a
healthier diet are modeling, feeding styles, and availability of food (Gidding et al., 2009). These
influences can be accomplished for school age children within the school environment.
According to Gidding et al., school programs that take advantage of a multi-faceted approach are
more likely to be successful (2009). School programs that have seen success include access to
healthier food, nutrition education, implementation of a school wide get healthy initiative, and
increase in daily physical activity (Gidding, 2009). With a majority of school aged children
eating one to two meals per day at school, it has become the responsibility of schools to
influence children towards better nutrition for a healthier life and the prevention of life
threatening disease.
The article written by Retelny, Neuendorf, & Roth, highlights, as a top priority of public
agenda, the prevention of cardiovascular disease (CVD) through nutrition, as well as, practical
implications (2008). More than a half century of studies pinpoint a positive correlation between
dietary factors and heart disease risk, which has produced a number of evidence-based nutrition
guidelines for prevention (Retelny, Neuendorf, & Roth, 2008). The American Heart
Associations guidelines include the whole foods approach which incorporates increased
consumption of fruits, vegetables, whole grains, fish, soy protein and nuts (Retelny, Neuendorf,
& Roth, 2008). One main factor to reduce risk factors for CVD is lowering levels of cholesterol.
Studies have shown that soluble fiber has a great effect on reducing cholesterol (Retelny,

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Neuendorf, & Roth, 2008). Soluble fibers such as oat bran, pectin, guar gum, and psyllium are
among the class that help reduce cholesterol (Retelny, Neuendorf, & Roth, 2008). Additional
foods high in soluble fiber are rye, barley, fresh fruits, fresh vegetables, legumes, sugar beets,
seeds, seaweed, chicory, and wheat (Retelny, Neuendorf, & Roth, 2008). Certain fatty acids play
an important role in the reduced risk of CVD. Good sources of these specific fatty acids include:
mackerel, salmon, herring, trout, sardines, tuna, flaxseed, walnuts, canola oil, and soybeans
(Retelny, Neuendorf, & Roth, 2008). One study done using 1822 free-living men aged 40-55
years old reported that the men who consumed more than 35g of fish per day showed
significantly reduced relative risks of death from Coronary Heart Disease, or CHD (Retelny,
Neuendorf, & Roth, 2008). Studies also show that plant sterols and stanols have cholesterollowering effects (Retelny, Neuendorf, & Roth, 2008). According to Retelny, Neuendorf & Roth,
plant sterols/stanols are found in many plant foods, such as vegetable oils, nuts, vegetables, and
fruits (2008). In order for optimal health benefits of nutrition for the prevention of disease,
access to beneficial foods and nutrition education should be a part of early childhood learning
and lifestyles. Schools remain the most ideal environment to accomplish these goals.
A report written by Bennett et al, which used a multitude of studies to focus on the
connection between nutrition and the prevention of diseases (2015). As part of this report many
studies were cited in order to discuss the links between nutrition and the prevention of disease.
According to Bennett et al., these studies have found numerous dietary risk factors for diabetes
(2015). The quality of dietary fats and carbohydrates consumed has been found to have a high

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level of effect on the risk factors for diabetes (Bennett et al., 2015). Increasing the consumption
of fresh fruits, vegetables, whole grains, legumes, and nuts along with the decrease of
red/processed meats, sugar sweetened beverages, and refined grains are strongly associated with
a decreased risk for type 2 diabetes (Bennett et al., 2015). With the ever increasing numbers of
individuals living with type 2 diabetes, and the link between risk factors and nutrition, it has
become extremely important for nutrition education to begin an early age.
In a study conducted by Steyn, Lambert, and Tabana, the objective was to evaluate
interventions in preventing type 2 diabetes (2009). Studies reviewing several school based
prevention programs were used as pilot studies for this research (Steyn, Lambert, and Tabana,
2009). Steyn, Lambert & Tabana evaluated 30 research programs that consisted of peer-reviewed
studies, included a minimum of fifty subjects, a healthy eating and/or physical activity
component, and prevention of type 2
diabetes as a primary goal (2009). One such school based program involved 458 students, 6-12
years old, two elementary schools, a control group, a 3 year study with interventions and control
groups and
evaluated at 8 years (Steyn, Lambert, and Tabana, 2009). The interventions in this study
included a health education program, community based activities, environmental changes, and
food services at school (Steyn, Lambert, and Tabana, 2009). Another study involved 58 children
in 4th grade with objectives to decrease saturated fat intake, increase fiber intake and physical
activity in African-American children (Steyn, Lambert, and Tabana, 2009). The interventions

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included health curriculum, physical education class, school cafeteria interventions, family
programs, and after school health clubs (Steyn, Lambert, and Tabana, 2009). The overall
conclusion from all thirty studies was that there is a large amount of evidence that lifestyle
interventions under a number of conditions helps to reduce the risk and occurrence of type 2
diabetes (Steyn, Lambert, and Tabana, 2009). In order to provide for long term solutions, the
study states that interventions need to be made a part of the regular routine in schools (Steyn,
Lambert, and Tabana, 2009). It is strongly suggested that interventions incorporate
recommendations given by the American Diabetes Association, such as, keep an ideal weight, eat
proper portion sizes, consume more whole grains, fruits, vegetables, fiber, lean meats, and
increase daily physical activity (Steyn, Lambert, and Tabana, 2009).
A study by Bell et al., provided for an objective of determining the impact of an
intervention designed to modify practices in child-based systems to support healthy eating
(2015). The interventions included training, resources, incentives, follow-up, performance
monitoring and feedback (Bell et al.,
2015). The study was conducted over a 20 month time period and involved 240 child-care based
services (Bell et al., 2015). The results after training and interventions was that the services were
significantly more likely to offer children milk and water as beverages, as well as, involve
parents in nutrition and programming (Bell et al., 2015). They were also more likely to have
nutritional guidelines and policies for home packed foods (Bell et al., 2015). In addition, menus

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were significantly more likely to provide meals that followed healthy eating guidelines (Bell et
al., 2015). The conclusion of this study
was that an implementation of interventions at the administration level was able of modify
policies and practices that supported healthier eating in child-based services (Bell et al., 2015).
Since this researched based information will be used to devise a program for nutrition and
the prevention of disease at Sousa Elementary School, it is important to understand the
demographic makeup of the school. Sousa Elementary is a public K-6th grade school in the Mesa
School District with a student enrollment of 560 students (Schooldigger, 2016). Sousa
Elementary School is located in east Mesa which is a suburban area located approximately 30
miles east of Phoenix in Arizona. During the 2013-2014 and 2014-2015 school year, Sousa
Elementary School was awarded an A rating (Arizona Report Card, 2014). Sousa serves a
student population who 51.1% qualify for free/reduced lunches, therefore, is classified as a Title
I School (Schooldigger, 2016). Sousa Elementary is populated with a student body which
consists of an ethnic makeup of 73% White, 20% Hispanic, 3% two or more
races, 2% African-American, 1% Asian, and 1% Native American (Schooldigger, 2016). The
average class at Sousa has a student to teacher ratio of 20 students per teacher (Schooldigger,
2016).
Synthesis of Information
The articles in this research and many years of research agree that there is a positive
correlation between dietary factors and certain disease risks. The information in the research

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used for this assignment has helped produce evidence-based nutrition guidelines for the
prevention of disease which includes a whole food approach. In order to educate people about
the importance of good nutrition for the prevention of disease, experts suggest an early
prevention program for children to be incorporated in schools. Since it has been concluded that
intervention is key to prevention, programs implemented in schools need to become a regular
part of the curriculum routine in order to have the greatest effect.
The information from these articles determined that in order to incorporate a health
education program that is effective it is important to implement health education, environmental
changes, family programs, community based activities, food services at school, and after school
health clubs. Some important factors that need to be included in the presentation of information
is keeping an ideal body weight, proper food portion sizes, and the reasons why it is important to
increase the consumption of whole grains, fruits, vegetables, lean meats, and fiber. Schools can
include health education programs that provide students with the information necessary for good
decision making and the opportunities for putting this learning into practice everyday.
The conclusion of the information in the articles is that the key to the prevention of
disease is proper nutrition which involves the education, food services, environmental changes,
family programs, and community involvement. The information also concluded that prior to
trying to implement a schoolwide program acceptance and modifications need to be made at the
administration level, within policies and procedures, and include practices that encourage and
support health eating. If schools implement programs that include these factors, students will

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better understand the future implications of their everyday choices. Students will also be able to
understand how their everyday choice can affect their health in the present day and in the future.
Practical Implications
In learning about the benefits of good nutrition in the prevention of disease, students need
to be able to bring information home, have opportunities to be involved in programs that
encourage proper nutrition, and have school-wide incentives in order to motivate students to eat
healthier. In order to accomplish this goal, a Food Smart program will be implemented and
will have three parts: a weekly brochure (Appendix A) that will contain one theme and two
feature foods of the week, a school-wide incentive program (Appendix B) which will encourage
students to eat the food of the week at least three times during that week, and a once a month
cooking demonstration and tasting (Appendix C). The cafeteria will offer the food of the week at
least three times per week in order to allow all students access to the food.
Since heart disease, diabetes, and cancer are three of the top seven causes of death in
America with heart disease still leading the way, it is important that schools help educate
students how to lower their risk of these life-threatening diseases in their futures (Nichols, 2015).
Food Smart will encourage students, staff, families, and community members to join together for
healthier eating in order to support each other in the prevention of disease. This program will be
geared towards all grade levels K-6 at sousa Elementary School. In implementing this program
the school guidelines will apply to include all students, all accommodations, and differentiation
will be provided whenever necessary. For example, if a student has a particular food allergy, i.e.
nuts, a substitute food of the week will be addressed in the bi-weekly brochure, such as seeds,
and be offered in the cafeteria. The program will utilize the following components to help

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support this goal: proposal, funding, marketing, nutrition education, student incentive, family and
community involvement, and technology.

Proposal
In order to receive approval from student council for the student incentive program, the
principal for the additional category/certificates in the end of the month assembly, and the once a
month
cooking/tasting demonstration, current research will be presented. Over the past 50 years there
has been a significant decline in the mortality rates caused by heart disease (Gidding, et al.,
2009). Preventative measures have contributed to more than half of this decline (Gidding, et al.,
2009). The current recommendations from the American Heart Association, the American
Diabetes Association, and the Dietary Guidelines for Americans, all coincide and emphasize
increasing whole grains, fruits, vegetables, lean meats, fish, nuts and legumes (Gidding, et al.,
2009) & (Steyn, Lambert, and Tabana, 2009). Educating students, and staff according to the
recommendations will also help the school meet the National Standards for School Meals with
higher quality foods that contain more nutritional value (Nutritional Standards, 2012). The
information presented will also tie in physical, mental, emotional, and academic benefits from
healthier eating.

Funding
In order to have adequate funding for ,Food Smart, four different avenues will be utilized
to cover the costs. First, a proposal will be presented to student council to cover costs associated
with the school-wide incentive program. The Principal will be presented with a proposal for the
certificates, and addition to the month end assemblies. Fundraising and donations will be
implemented as strategies for the cost of the once a month cooking and tasting demonstrations.

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Finally, the committee will research and apply for any appropriate local, state or federal grants
that the program may qualify for.

Family and Community Involvement

Local and community partners will be approached for donations and at least three
different fundraisers will take place prior to implementing the evening demonstrations. Families
and community partners will receive the bi-weekly brochure (Appendix A) with foods of the
week and information on disease prevention. A link to the healthy eating website will be posted
on the brochure so families can join in the learning and participating. Families and community
partners will be invited to the once per month cooking demonstration.

Marketing/Technology
The next step after approval and funding are secured will be to implement the schoolwide incentive program (Appendix B). Each teacher in the school will put up a healthy eating
chart in their classroom and a large chart will be put up in the cafeteria to track students eating of
the food of each week. Teachers will also dedicate a portion of class each week for nutrition
education with a focus on the food of the week and disease prevention. The healthy eating
committee will design the brochure (Appendix A) every two weeks to either by emailed or sent
home for information about the foods of week for the next two weeks, health benefits and
disease prevention. Families and students will be encouraged in the brochure to include the food
of the week into their eating that week and report their eating to their teacher for chart activity.
The cafeteria will add the food of each week to the menu at least three times per week to give all
students access to the food. A link to healthy eating website will be placed on the schools
website. In addition, posters will be put up around the school about the once per month cooking

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demonstration/tasting, as well as, highlighted information will be put in the school newsletter.
We will ask for RSVP one week prior to demonstration in order to adequately prepare.

Nutrition Education
Since the program contains a nutrition education and cooking component, there will be
consistent opportunities for teachers and cooking demonstrator to add in math, science, reading,
and social studies components. Teachers could incorporate short articles about the food of the
week, show portion sizes, demonstrate how the body utilizes nutrients, explore how different
cultures use the foods differently, or ask students to search for recipes containing the food of the
week. There are many ways to incorporate standards and objectives, so the committee will give
teachers the option for specific lessons or create their own. The cooking demonstrator will be
given specific focuses for the month and will incorporate those academic components into the
demonstration.

Student Incentive
In order to kick off this program, there will be a school-wide assembly in which the
program will be presented with music, skits, and fun facts. The students will be introduced to the
school-wide incentive program (Appendix B), the new brochure that will be going home every
two weeks (Appendix A) , and the once a month cooking demonstration/tasting (Appendix C).
Students will leave the assembly with their own personal chart to fill out once the program
begins. Once they eat a food of the week, they will get their personal chart signed and dated and
show their teacher for participation in their classroom charting as well as the school-wide
charting. When students fill the chart in the cafeteria with a sticker for each week of the month
they will receive a school-wide grabber as well as be presented with a healthy eating certificate
at the month end assembly.

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The programs aim is to educate students in nutrition and the role it has on the prevention
of disease. For students to understand the importance of proper nutrition and the key role it plays
in lowering the risk of fatal diseases, they must have incentive, education, and connected
involvement at home and in the community. This program incorporates all these aspects in order
to ensure the success of this nutrition education and better food choices for the end result which
is healthier lives and lower risk for diseases in the future.

Appendix A: An example of the bi-weekly healthy eating brochure

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Appendix B: The following is an example chart for a month of healthy foods and examples of
recipes for the cooking demonstration:

WEEK 1

WEEK 2

WEEK 3

WEEK 4

MONDAY

ALMONDS

ORANGES

BANANAS

OATMEAL

TUESDAY

BLUEBERRIES

TUNA

CARROTS

CANTALOUPE

WEDNESDAY

BROCCOLI

STRAWBERRIE
S

TOMATOE
S

GRAPEFRUIT

THURSDAY

SEEDS

70% DARK
CHOCOLATE

DARK
GREEN
LETTUCE

APPLES

FRIDAY

RASPBERRIES

WALNUTS

WHITE
CHICKEN

WHOLE
GRAIN
BREAD

Appendix C: The evening cooking demonstration will be held every third Wednesday of the
month. Each family attending will receive nutritional information and a copy of the presented
recipe.
A few examples:

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Conclusion
For the first time ever the current generation is facing a future that is less healthy and
will have a shorter life expectancy than their parents. In order to reverse this occurrence and help
children understand the everyday decisions that are important for healthier lives and futures,
research point to schools to implement programs to change the direction of health in our country.
Since there is a positive
correlation between proper nutrition and the prevention of life-threatening diseases, it is critical
to implement early childhood prevention measures in order to experience the greatest impact for
change. The school wide Food Smart program will accomplish the goal of educating adults and
children in the importance of proper nutrition for the prevention of disease. The program will

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educate staff, modify policies, educate students and their families, provide opportunities for
healthier eating, and will encourage 100% participation through incentive.
Once implemented, in the first year Food Smart will be adjusted as necessary in order to
make it an extremely effective and loved program, so that it will be attractive for other schools to
implement with relative ease. In the first year, data will also be collected for assessment of
effectiveness, and for adjustments for future implementation. Within three years the program
goal is to have district wide implementation. The plan would include distribution of a formal
detailed plan with implementation strategies, school visits, staff meeting appearances followed
up by training sessions, board meeting appearances with presentation, and check-ins for progress
and development. Within five years, the program goal is implementation in other school
districts in the state. A similar process for information sharing and implementation strategies will
be continued for other school districts. The benefit of implementing this program in our state will
be healthier children with the changed possibility to be even healthier than the generation before
them. The children of this generation will have more education in proper nutrition and the
benefits in order to make better decision in their everyday lives when it comes to eating and
lifestyle. Schools have the time, environment and opportunity to educate children in academics
as well as all important areas of live in order to produce a positive, healthy, future generation for
the benefit of people everywhere.

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References
Gidding, S., Lichtenstein, A., Faith, M., Karpyn, A., Mennella, J., Popkin, B.,
Rowe, J., Van Horn, L., & Whitsel, L. (2009). Implementing AHA pediatric
and adult nutrition guidelines. AHA Journals. Retrieved from
http://circ.ahajournals.org/content/119/8/1161.full.
Nichols, H. (2015, September, 21). The top ten leading causes of death in the US. Medical
News Today. Retrieved from http://www.medicalnewstoday.com/articles/282929.php.
Nutrition Standards in the National School Lunch and School Breakfast Programs.
(2012, January 26). Federal Register, 77(17), 4088-4089. Retrieved from
http://www.gpo.gov/fdsys/pkg/FR-2012-01-26/pdf/2012-1010.pdf.
Steyn, N., Lambert, E., & Tabana H. (2009). Nutrition interventions for the prevention of type 2
diabetes. Proceedings of the Nutritional Society. 68(1). 55-70. Retrieved from
http://journals.cambridge.org/action/displayFulltext?type=6&fid=3822136&jid=
PNS&volumeId=68&issueId=01&aid=3822132&bodyId=&membership
Number=&societyETOCSession=&fulltextType=RA&fileId=S0029665108008823.
Spiced Chicken with Couscous Salad. Image retrieved from
http://cdn-image.realsimple.com/sites/default/files/styles/rs_main_image/public/image/
images/1006/dinner-chicken-couscous_300.jpg?itok=18WuSlSi.

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Teriyaki Salmon with Zucchini. Image retrieved from

http://cdn-img.health.com/sites/default/files/migration/images/gallery/eating/
Teriyaki-salmon-hl-523893-400x400.jpg.

Link to website:
http://kimephillipsseportfolio.weebly.com/