Exam card 7.

1.
2. Poor diet as a health risk.
1) Definition and magnitude of the problem.
a. Definition of the problem
i. Evidence suggests a relationship between diet and certain
noncommunicable diseases.
ii. Proportions of the constituents of diet are important.
iii. There is increased risk of disease in high proportion of
dietary fat (especially certain saturated fats), excess
energy intake, high salt intake, cholesterol, refined sugar,
alcohol.
iv. There is also increased risk with low intake of
polyunsaturated fats, complex carbohydrates and dietary
fibre, antioxidants (vitamins A,C and E) and minerals
(selenium, iron, calcium).
b. Magnitude.
i. According to data by the Food and Agricultural
Organization of the United States (FAO), most of
population of Europe consumes too high a proportion of
energy from fat (>35%), and has risen in the past 20
years.
ii. Northern and Western countries have reached a level of
40%
iii. Southern, central and eastern countries and former USSR
started with lower level but experienced a rapid increase.
iv. Too little fibre and too much sugar and salt are common
problems.
v. Noncomunicable diseases closely associated with poor
diet are cardiovascular diseases, cancer, obesity and
diabetes. These are among the leading causes of illness
and death in Europe.
vi. Proportion of death by cardiovascular disease is falling.
Mortality from cancer shows unfavourable trend.
vii. In cebtral, eastern and former USSR countries have
different cause specific mortality. There is very high
mortality from cardiovascular diseases and rapid rise in
cancer.
viii. Overweight and obesity is prevalent especially in middle
aged women.

ix. Adult onset NIDDM is 1%.

2) Health risks attributed to dietary factory.
a. Increasing blood cholesterol, saturated fat, and dietary
cholesterol predispose to atherosclerosis and platelet
aggregation leading to coronary heart disease, stroke, peripheral
arterial diseases. There is also a role for complex carbohydrates,
salt intake and dietary fibre.
b. High total at especially saturated, high total energy intake are
associated with cancer of breast, colon and rectum,
endometrium and ovraries.
c. High salt consumption is attributed in gastric cancer.
d. Low intake of dietary fibre attributed to colorectal or breast
cancer.
e. Obesity is associated with increased risk of NIDDM, high
blood pressure, stroke, some cancers.
f. Low supply of dietary calcium and vitamin D particularly
during growth can cause osteoporosis.
g. There is also increased risk with low intake of polyunsaturated
fats, complex carbohydrates and dietary fibre, antioxidants
(vitamins A,C and E) and minerals.
h. Complex carbohydrates prevent diverticular disease of the
bowels.
3) Intervention measures and recommendations on healthy eating and
disease prevention in primary care.
a. Should have necessary knowledge and skills to provide
accurate information and well aimed advice to help overcome
potential barriers of changing diet.
i. Familiar with cultural and traditional eating patterns
ii. Well informed on availability of foods
iii. Aware of cost of healthy foods.
iv. Able to ensure advise on healthy shopping and healthy
food preparation is understood.
v. Tactful in persuading to change eating habits
vi. Prepared to answer questions
b. Should take steps to make international recommendations on
nutrition, seek opportunities to raise and discuss diet-related
health risks and benefits of healthy eating. Inquire on patients
eating habits and include in medical records.

c. Help change diet whenever justified

i. Discuss positive features of patients current diet
ii. Discuss harmfulness of their eating habits
iii. Motivate people to change harmful eating habits
iv. Challenging misconceptions about a healthy diet
v. Give positive and practical suggestions
d. Give model of good value, delicious, satisfying meals that are
healthy.
e. Provide advise on how to:
i. Reduce fat intake
ii. Increase intake of starch and fibre
iii. Reduce sugar consumption
iv. Reduce salt intake
f. Monitor nutritional status and advise to maintain healthy body
weight
g. Pay attention to people with special nutritional needs
i. Children, adolescents, pregnant and lactating women,
elderly and sick people, vegetarians etc.
h. Advocate dietary change in the community through
supermarkets, schools, workplaces, restaurants etc.
4) Effective nutritional public health measures.
a. National nutrition policies
i. Include education, legislation, and regulations.
ii. Require coordination between health and agricultural
policies and food industry (iin production, processing,
price control and quality).
b. Dietary recommendations
i. Consistent with good nutritional practices, promotes
healthy eating and reduces risk of chronic disease.
ii. Same diet prevents cancer, heart disease.
c. Education and public information
i. In schools, workplaces, supermarkets and restaurants.
d. Nutrition policy to recommend a healthy diet and urge to:
i. Reduce fat consumption to 15-30% of total energy intake
with maximum 10% saturated, and maximum 7%
polyunsaturated. Cholesterol < 300md/day.
ii. Increase complex carbohydrates 50-70% of total energy
intake. 400g minimum of vegetables and fruit.
iii. Resuce sugar to 60g/day.

iv. Reduce salt to <5g/day

v. Reduce alcohol sonsumption
vi. Reduce weight excess.
5) Difficulties in behavioral changes.