Nutrition and Chronic Illness

Kathaleen Briggs Early, PhD, RD, CDE

Assistant Professor of Biochemistry and Nutrition
kearly@pnwu.org

Learning Objectives
o Upon completion of this module,
the student will be able to:
1. Explain the severity of the worldwide
obesity epidemic
2. Identify how chronic diseases can be
prevented by proper nutrition and lifestyle
3. Identify what dietary regimens are
beneficial for chronic disease management
4. Explain why breastfeeding is the best choice
for infant feeding

Chronic Disease
o A long-term condition
e.g., obesity, diabetes, and cardiovascular disease
o May be prevented or delayed with lifestyle changes
e.g., healthier eating and more physical activity
o According to the WHO
by 2020, chronic diseases will account for almost
three-quarters of all deaths worldwide, and that 71% of
deaths due to ischaemic heart disease (IHD), 75% of
deaths due to stroke, and 70% of deaths due to diabetes
will occur in developing countries. The number of people
in the developing world with diabetes will increase by
more than 2.5-fold, from 84 million in 1995 to 228 million
in 2025. On a global basis, 60% of the burden of chronic
diseases will occur in developing countries.

Nutrition for Chronic Disease

Prevention and Treatment
o Nutrition is a widely accepted tool for prevention
of chronic diseases
o Nutrition is also very important for management
and treatment of a chronic diseases
o This presentation will discuss cardiovascular
diseases (e.g., heart disease and stroke), obesity
and diabetes, and how they can be prevented and
treated with nutrition

Classification

BMI(kg/m)
Principal cut-off points

Additional cut-off points

Underweight

<18.50

<18.50

Severe thinness

<16.00

<16.00

Moderate thinness

16.00 - 16.99

16.00 - 16.99

Mild thinness

17.00 - 18.49

17.00 - 18.49

Normal range

18.50 - 24.99

Overweight

25.00

Pre-obese

25.00 - 29.99

Obese

30.00

Obese class I

30.00 - 34-99

Obese class II

35.00 - 39.99

Obese class III

40.00

http://apps.who.int/bmi/index.jsp?introPage=intro_3.html

18.50 - 22.99
23.00 - 24.99
25.00
25.00 - 27.49
27.50 - 29.99
30.00
30.00 - 32.49
32.50 - 34.99
35.00 - 37.49
37.50 - 39.99
40.00
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Value of waist circumference

o Location of excess fat is
important
o If excess fat is mainly around
midsection = more likely to
develop health problems than if
excess fat is mainly around hips
and thighs
Apple vs. Pear shapes
True even if BMI falls within the
normal range

Higher risk body

shape

Lower risk body

shape

o Women: waist measurement of

more than 35 inches (88 cm)
o Men: waist measurement of
more than 40 inches (102 cm)

Use BMI and Waist Circumference

o Use it with every patient visit
o Can identify those patients at risk for
chronic disease with confidence
o Should be incorporated into vital signs and
patient check-in procedures
o Quick, cheap, and easy to do!

The role of genetics in body weight

o Epidemiological evidence shows that obesity,
excess energy (Calorie) intake, and sedentary
lifestyle are primary contributors to the chronic
disease epidemic
o 40% of BMI is attributable to independent
genetic influences

Obesity and Nutrition Transition

Obesity in the developing world can be seen
as a result of a series of changes in diet,
physical activity, health and nutrition,
collectively known as the 'nutrition transition.'
As poor countries become more prosperous,
they acquire some of the benefits along with
some of the problems of industrialized
nations.

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Worldwide Obesity Epidemic

o 2.5 million deaths can be attributed to
overweight/obesity worldwide
o Nearly 70% of cases of CVD are associated with obesity
o Worldwide, more than 1.1 billion overweight adults
At least 312 million of them are clinically obese
By the end of 2010, an estimated 43 million children under
five will be overweight

o Obesity levels range from 20-30% in European countries,

to over 70% in Polynesia
o By 2015, the worldwide obese population will reach
1.5 BILLION
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Diabetes
o Characterized by increased blood glucose (sugar)
levels
o Due to
1. a lack of insulin (a hormone), which controls
blood glucose levels
And/Or

2. an inability of the bodys tissues to respond

properly to insulin (a state called insulin
resistance)
o The most common type of diabetes is type 2
o Diabetes can benefit from good nutrition
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Types of Diabetes
Type 1 diabetes
an autoimmune condition resulting in the need for
lifelong insulin therapy

Type 2 diabetes
Progressive disease related to insulin resistance
May be managed with just diet and exercise, or may
require oral medication and/or insulin injections
Most commonly seen in overweight/obese people, but
can also develop in normal weight people

Gestational Diabetes
Diabetes that develops during pregnancy
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Nutrition for Diabetes

o Goal of nutrition therapy
To help people with diabetes learn how to make
healthy food choices, which will optimize
glycemic control and prevent complications
A healthy, well-balanced diet
There is no one diabetic diet
Healthy eating for diabetes includes whole grain
cereals, lean protein foods, fruits, generous portions
of non-starchy vegetables
Ideally, a person with diabetes receives an
individualized meal plan from a nutritionist or
dietitian
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Nutrition for Diabetes

Questions to ask patients:
What are the food-related factors that increase ones
chance of developing diabetes?
Answer: Obesity (in part due to excess food
intake) is the only food-related cause of diabetes.
Eating too much sugar does not cause diabetes.
What are the factors that influence eating habits?
There are many factors that influence food
choices and eating habits. Economic and family
situation, geography and cultural all contribute to
food choices.
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Nutrition for Diabetes

Questions to ask patients:
What types of foods do you normally eat?
This allows identification of healthy vs. less healthy eating
patterns

What types of foods do you eat after waking?

Carbohydrate foods are less well-tolerated in the morning
hours during pregnancy

Are you able to monitor your blood sugar?

If patients have access to a glucometer and test strips,
monitoring post-meal blood sugars can be a useful tool in
assessing dietary factors
Elevated post-meal blood sugars may indicate too much
carbohydrate is being consumed, or inadequate medication
or insulin is being provided
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Managing Type 2 Diabetes

o Glycemic Control
Self-monitoring should only be considered
when the person with diabetes and their
health care team is prepared to learn the
skill, record the findings, understand the
data, and act appropriately on the data
Desired plasma glucose levels are <6.0
mmol/l (<110 mg/dl) before meals, and <7.8
mmol/l (<140 mg/dl) 2 h after meals.
Allow higher targets for patients on insulin or
sulfonylureas at risk for hypoglycemia
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Managing Type 2 Diabetes

o Provide dietary counseling that optimizes a
healthy weight and reduces cardiovascular risk
profile (e.g., low fat, low salt)
o Using the plate method is one way to instruct
lower-literacy patients on a healthy diabetes
meal plan

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The Plate Method

o Easy to teach
o Easy to understand
o Based on dividing portions
onto a standard 9 plate

19

http://www.dlife.com/diabetes/information/inspiration_expert_advice/expert_columns/Pr
escriptionSolutionsPlatePlannerEnglish_LetterSize_3-09.pdf

20

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Cardiovascular Disease
o Caused by disease of the blood vessels
(atherosclerosis) of the heart, usually as part
of the process which affects blood vessels
more generally
o Stroke and heart disease are the main
cardiovascular diseases
Stroke is the main cardiovascular disease in many
east Asian countries

22

Nutrition for Cardiovascular Disease

o Eat a diet rich in fruits, vegetables and whole cereal
grains
This provides potassium and fiber, both clearly linked
to reduced chronic disease risk
o Dont add salt during food preparation
o Limit use of processed and pre-prepared food items
They are typically very high in salt
o Cook with no or very minimal added fats and oils
If fat or oil is used, unsaturated is healthiest option
(canola, olive, etc)
o Maintain a healthy body weight
o Control blood pressure and blood sugar
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Successful Long-term Weight Control

o Long-term behavioral treatment, whatever
form it takes, encourages patients to practice
four key behaviors
1. Exercise regularly
2. Consume a lower-calorie diet
3. Monitor weight regularly
4. Record food intake and physical activity

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Preventing Chronic Diseases

o Maintain a healthy body weight
The WHO goals are
For an adult median BMI of 21 to 23 kg/m2
For individuals, the recommendation is to
maintain a BMI in the range 18.5 to 24.9 kg/m2
and to avoid a weight gain greater than 5 kg
(11 pounds) during adult life

25

Preventing Chronic Diseases:

Physical Activity
o Stay physically active
The WHO goal is for all people to get
one hour per day on most days of the
week of moderate-intensity activity,
such as brisk walking

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Preventing Chronic Diseases:

Breastfeeding
o Infants should be breastfed for at least 6 months
o Breastfeeding is convenient
Food is readily available for the infant, and requires
no special preparation or equipment
o Provides the best balance and quantity of nutrients
ideal for the human infant
o Both colostrum and breastmilk have anti-infective
constituents that help limit infectious disease
o Bottle feeding increases risk of infections from
contamination with pathogenic organisms in the milk,
the formula and the water used in preparation, as well
as in bottles, teats (bottle nipples) and other items
used for infant feeding
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Preventing Chronic Disease:

Breastfeeding
o More economical than bottle-feeding
Bottle feeding involves costs for infant formula
the bottles and teats and the fuel necessary for
bottle sterilization
o Prolongs the duration of post-partum anovulation,
helping mothers to space their children
o Enhances bonding and relationship between mother
and infant
o Seems to reduce the risk of allergies, obesity and
certain other health problems
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Preventing Chronic Diseases:

Summary Points
o Chronic diseases can be prevented with lifestyle
changes
Lifestyle changes include healthier eating, increasing
physical activity, and smoking cessation

o Very active populations with diets rich in

vegetables, legumes, fruits and whole grains
may have a total fat intake of up to 35% of total
calories without the risk of unhealthy weight
gain. WHO, 2003

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Contact Information

Kathaleen Briggs Early, PhD, RD, CDE

kearly@pnwu.org