NUTRITIPON

1. Nutrition and the Diseases
of
Lifestyle
The practical modifications
that should be made in our day to day diet
to reduce risk of lifestyle diseases

2. Nutrition - the foundation of good
health and freedom from disease.
Significance of nutrition
 Adequate nutrition - for growth, development and maintenance
 Under nutrition contributes to 60% deaths amongst U5C (WHO,
2002)
 More than 44% children in India suffer from malnutrition
 About 55% men and 75% NPNLWomen are anaemic
 Chronic degenerative disorders like CVD, Hypertension, Type
2DM , certain cancers, etc are related to diet and nutritional status
 Obesity association with higher risk of developing CaBr, colon,
endometrium, gallbladder, esophagus, pancreas, etc.
 Consumption of foods rich in dietary fiber and antioxidants is
associated with reduced risk of certain cancers
 Under nutrition during fetal and early childhood is known to be

3. Role of Food
 a) Food builds body tissues
 b) Food regulates body processes
 c) Food supplies energy
 d) Food gives us enjoyment
Interplay between
Malnutrition and Infection !!

4.  RDA are the estimates of nutrient intakes which
individuals in a population group need to
consume to ensure that the physiological needs
of all subjects in that population are met.
 Corresponds to mean intake of the given
nutrient + 2 Standard Deviation (that is about
25% of the mean has been added). It covers the
requirement of 97.5% of the population. This is
the safe level of intake and the chances of this
level being inadequate is not more than 2.5%.
 Can the RDA be Applied to Individuals?
 For RDA of energy only the average
requirement is considered.

5.  Reference Indian adult man is between
20-39 years of age and weighs 60 Kg.
He is free from disease and physically fit
for work.
On each working day he is employed for 8
hours in occupation that usually involves
moderate activity.
While not at work he spends 8 hours in
bed, 4-6 hours sitting & moving about and
2 hours in walking and in active recreation
or household duties.

6.  Reference Indian Adult Woman :
is between 20-39 years of age and
healthy; she weighs 50 Kg.
She may be engaged in general
household work, in light industry or in any
other moderately active work for 8 hours.
While not at work she spends 8 hours in
bed, 4-6 hours sitting and moving about in
light activity and 2 hours in walking or
active household chores.

7. Energy Requirements of Reference Indian
Man and Woman
Sex Body
weight
(Kg)
Activity levels
Sedentary Moderate Heavy
Male 60 2425 2875 3800
Female 50 1875 2225 2925

8. As per the principles of Ayurveda, the diet
is supposed to change with the time of
the day and seasons. ‘Hot’ and ‘cold’
temperaments of the food are supposed
to be balanced with the weather,
seasons and climate.
These dictums were ingrained in the
lifestyle along with good and noble
thoughts (vichara) and the discipline of
life (Yoga) for a long lasting good health
and the ultimate union with the supreme
power.

9. Price of unregulated urbanization,
industrialization and increasing
level of affluence the so called
“modernization” is tremendous
load of “Non-Communicable
diseases ”/ “Chronic - diseases” /
“Lifestyle Diseases”.
The issue is a global phenomena
and not simply restricted to the
developed, rich countries.

10. Major “Lifestyle Diseases”
 Obesity,
 Heart Disease
 Hypertension, Diabetes Mellitus
 Oral cancer, Lung cancer
 Breast cancer, Colonic cancer & Other
cancers,
 Sexually Transmitted Dis.
 HIV & AIDS, Mental Stress and its sequel
 Osteoarthritis, Osteoporosis
 Liver Disease, Asthma and Bronchitis
 Road accidents

11. What is “Lifestyle”
“Lifestyle”, indicates the behavioural
patterns which we routinely adopt and
the way we tend to (involuntarily) live
our daily life, unless coerced to
change by some external stimulus.
Lifestyle is thus mainly dependent on
psycho - social and environmental
factors and, to a smaller extent, on
genetic influences.

12. The Major Components of Unhealthy
Lifestyle
 Lack of physical activity
 Faulty dietary habits
 Tobacco use
 Excessive alcohol intake
 Mental Stress
 Disregard to personal safety regarding
- Accidents
- Personal hygiene
- Promiscuous Sex
- Insect Vectors of Diseases

13. Eat adequately
Cereals : 350 ~ 400 g
Pulses : 50 ~ 100 g
Eat liberally
Veg : 200 ~ 250 g
Fruits : 200 ~ 250 g
Eat Moderately
Non veg < 100 g
Sugar : 50 ~ 60 g
Eat
Less
Salt 6g
Fats 30g
The principles of a healthy diet for an average adult
(consuming 2500 to 2800 Kcal per day)

14.  Healthy Diet include Foods with
◦ low calories (and low refined
sugars),
◦ enough proteins,
◦ low fats and salts but lots of
antioxidants, vitamins and natural
fibre.
And Should Provide
 The Required Energy, No More
and No Less, and
 Psychological satiety

15. X

16. Epidemiology of Obesity
Obesity:
 Commonest expressions of unhealthy
diet,
 Often combined with lack of physical
activity.

17. Burden Of Disease
WHO –
 Globally, over 1 billion (16%) adults are
overweight and 300 million (5%) are obese.
 The highest rise is in fast growing economies
especially of South East Asia.
 250 million obese in the third world countries
 India - > 100 million,
(12.6% women/ 9.3% men)
We are truly in the midst of an obesity
epidemic, with serious health ramifications.

18. Epidemiological Determinants
Obesogenic environment :
 Affluent lifestyle
 Wrong food
 Sedentary home environment,
 Vanishing old family traditions, replaced
by the ‘couch - potato’ culture
 Cut throat competition
 Quick money
 LOSS OF VALUES

19. Epidemiological Determinants
Age :
 The incidence increases with age till about
60years.
 Vulnerability is maximum around 40 years
Gender :
 More in females - inherent hormonal
differences.
Ethnicity :
 Large unexplained variations in different
ethnic groups.

20. Epidemiological Determinants
Education & Income levels :
 In Indian setting, higher education & Income
level-obese,(likely to be more affluent).
 In the west, however, scene is reverse.
Marital status :
 Married are more likely to be obese
Parity :
 Women with higher parity are more likely

21. Epidemiological Determinants
Diet :
 A diet rich in fats, refined sugar and
carbohydrates
 Consumption of as little as 100 extra
calories per day would increase the weight
of an individual by 4 kg in one year.
Smoking :
 An anorexic agent, not to be
promoted!!!!!!!!
Alcohol :
 Alcohol provides 7kcal per gm (+
Snacking!)
Physical Inactivity :

22. Causes of Obesity
 Increased energy intake and
decreased expenditure :
 Passive overeating :
 Binge eating :
 Metabolic factors :
 Genetic factors :
 Foetal programming :

23. Critical Periods for Weight Gain
Weight gained during certain critical
periods !
◦ Age range of 12 to 18 months
◦ Age range of 12 to 16 years
◦ Gain of 60% (or more) of his ideal
weight by an adult
◦ Weight gain during pregnancy

24. Quantifying Obesity
Body Mass Index = Weight (Kg) / Height (m)2
Grades of obesity based on BMI
BMI Classification Risk of Co-morbidities
< 18.5 Underweight Low to Average
18.5-24.9 Normal weight Average
25 - 29.9 Pre-obese
(Overweight)
Mildly increased
30 - 34.9 Obesity Class I Moderate
35 - 39.9 Obesity Class II Severe
> 40 Obesity Class III Very severe

25. Grades of Obesity based on BMI for Asians
BMI Classification Risk of Co-
morbidities
< 18.5 Underweight Low
18.5-23 Normal weight Increasing but
acceptable
23 -
27.5
Pre-obese
(Overweight)
Increased
> 27.5 Obese High
Waist circumference :
Normal, ≤ 90 cm for men and 80 cm for
women
Waist - Hip Ratio :
A ratio of < 0.9 for men and < 0.8 for women

26. Types of obesity
Gynoid / ‘Pear shaped’ :
 The fat is evenly (globally) distributed.
Android/‘Apple shaped’ :
 The fat is centrally distributed
 Commonly seen in men of the South
East Asian region, including India.
 Visceral (peritoneal) deposition of fat -
Higher waist circumference or higher
WHR

27. Hazards of obesity
 Higher risk of mortality and morbidity.
 The LE of a morbidly obese individual is
about a 10 yrs lower
 Most overweight and obese individuals
have difficulty in day to day activities
and are
 Prone for Life Style Diseases

28. Some Specific clinical Consequences
: Metabolic & Degenerative :
 Diabetes type II (50 to 100 times more in obese)
 Hyperlipidaemia, IHD, Hypertension (5 to 6 times
commoner),
 Stroke (2.5 to 6 times commoner),
 Gall stones, breast and colon cancer, infertility,
gout and polycystic ovary syndrome
Physical :
 Osteoarthritis, chronic back pain, respiratory
problems, limited mobility, higher accidents, slee
apnoea and skin problems.
Psychological :
 Depression, low self - esteem, social isolation,
poor employment status, impaired relationships
and discrimination.

29. !
“Most obese people won’t
enter treatment, most
who do;
won’t lose weight and
most who lose weight
regain it”

30. Prevention of Obesity
Prevention is the only viable long term
strategy
Losing 10 kg is associated with :
 A reduction in total mortality by 20%
 A reduction in systolic BP by 10 mmHg
 A reduction in diastolic BP by 20 mmHg
 A reduction in fasting glucose by upto
50%
 A reduction in total cholesterol by 10%
 A beneficial rise of 8% in HDL cholesterol
 An improved self - esteem

31. Prevention
Universal Measures:
Meant for all irrespective of their weight status.
Selective Measures:
High risk individuals are targeted;
Indicated Measures:
Or the Secondary Preventive (Early Dx & Tt)
measures are to be taken for those with
existing problems of overweight and obesity.

32. How to Reduce Weight?
Nearly 2500 years ago, Socrates had
very aptly said
‘Eat only when hungry and
drink only when thirsty, and
never to leave the table with a
feeling of satiety’.

33. How to Reduce Weight?
Aim for BMI < 25 kg/m2 (preferably <23.5)
The origin of obesity is multi-
factorial.
Modalities for treatment/prevention:
 The dietary therapy most practical and
effective
 Other measures are :
◦ (a) Behaviour therapy
◦ (b) Drug therapy
◦ (c) Surgical intervention
◦ (d) Genetic approach.

34. Dietary therapy (dieting) :
 Educate on nutritional and health aspects:
◦ How to make safe, sensible and gradual
change in eating pattern
◦ Increase the intake of complex
carbohydrates (unrefined cereals and
sugars, fibre rich foods) and decrease fats
and simple carbohydrates (refined sugars,
excessively milled cereals e.g. white
bread, maida, besan etc).
◦ Fruits and vegetables- an integral part of
diet.
◦ Low calorie and low fat foods.

35. Four areas to be considered
 Ascertain the activity status :
◦ Assess the present BMI and the desired BMI to
find out the weight (in Kg) to be reduced.
 Set a practical time frame for weight loss
 Assess the daily calorie intake.
◦ Translate weight to be reduced, to calorie
restriction.
◦ These calories are distributed between
carbohydrates, protein and fat so as to cut down
calories preferably from fats and carbohydrates (in
that order).
 Suitable substitutions should be made
◦ The frequency with which the foods are to be
eaten

36. Reducing weight - An example
Let us take a 1.66 m tall, sedentary male,
weighing 80 kg.
Step 1 :
His present BMI is 29. Let us presume that
his desired target BMI is 25.
To achieve this BMI his weight must be about
69 kg i.e. he must reduce 11 kg.
Step 2 :
It is recommended that he reduces 1.5 kg
weight per month, i.e. he would be able to
reduce 11 kg in about 7 months.
Step 3 :
Assess his total daily calorie intake.

37. Reducing weight –example…..
As a rule, generally; a reduction of about 500 Kcal
per day brings about a weight loss of about 500g
per week.
Conservatively, let us assume that a reduction
of 1.5 kg per month can be achieved.
500 Kcal per day can be reduced by cutting down –
15 g oil (135 Kcal), and about 90g (360 Kcal)
carbohydrates/ day.
Step 4 : Make suitable substitutions as applicable
For example, replace saturated fats with
PUFA/MUFA,
Replace whole milk with skimmed milk, and refined
flour with whole-wheat flour. More fruits and
vegetables could be included.

38. Making Some Wise Substitutions -
From Fat to Fit
 Refined carbohydrates with complex
carbohydrates
 High starch foods with high fibre ones
 Fried nuts with plain nuts
 Whole milk with low fat skimmed milk
 Mutton and beef with lean meat (e.g. chicken)
 Oily meat preparations with non-fried stews,
soups
 Chips, wafers, burgers, samosa, cutlets with
plain toast, fruits, salad and fruit juices
 Sweet biscuits with plain ones and nuts
 Saturated fats (ghee, butter) with vegetable oils?

39. Some more tips on dieting
 Do not skip meals to reduce weight
 Do not eat to finish leftovers
 Eat many small but measured meals
(minimum 3)
 Do not snack while watching TV or using
computer.
 It is a myth that some foods can burn fat
 Do not shop when hungry
 Do not use food as relaxation
 Develop a positive attitude and be cheerful
 Exercise regularly, Strengthen muscles
 Slow and steady weight loss of about 0.5 -
1kg per week is safest

40. Remember:
 Food labels claiming ‘low-fat’ or ‘no-fat’
may still have lot of calories
 Food labels claiming ‘zero cholesterol’
may not mean ‘zero oil’
 Drink enough water each day @
minimum of 8-10 glasses
 Alcohol has high calorie content; Snacks
taken along with drinks add to calories
 Fruits and vegetables are low calorie
food and source of antioxidants

41. Fad diets and their role in weight reduction :
 More popular ones are the Atkins diet, Ornish
diet, Weight watchers diet and the Zone diet.
These are based on different
‘principles’ -
 Atkins diet, the most popular of the lot,
restricts intake of carbohydrates to less
than 30 g a day and permits consumption
of fats (fatty meat, butter, and other high -
fat dairy products).
 The Ornish diet restricts fat,
 Weight watcher’s diet restricts portion size
and calories,
 Zone diet modulates macronutrient
balance and glycemic load

42.  The Atkins diet books have sold more than
45 million copies over 40 years all over the
world.
 It eliminates carbohydrates from food without
restricting protein and fat intake.
 Deprived of carbohydrates, the body uses fat for
fuel.
 A small part of metabolized fat is eliminated in
the urine as ketone bodies, and this is why such
diets are called “ketogenic”.
 In the short run, such diets produce rapid weight
loss due to polyuria.
 The apparent paradox that ad - libitum intake of
high - fat foods produces weight loss might be

43. (i) Severe restriction of carbohydrate
depleting glycogen stores
(ii) This leads to excretion of bound water
causing weight loss
(iii) The ketogenic nature of the diet being
appetite suppressing
(iv) The high protein - content being highly
satiating
(v) High fat / protein diet reduces
spontaneous food intake
(vi) In the absence of carbohydrates the food
choices are limited, leading to decreased
energy intake

44. Consequences
Wrong dietary habit- due to less appetite
patients eat without feeling severe hunger
and without measuring their food intake!
Orthostatic hypotension, fatigue and nausea
are frequent.
The diet increases plasma cholesterol and
uric acid. May be dangerous in diabetes
(anorexia, acidosis) and in heart or kidney
disease.
On the long run, re - feeding
carbohydrates cause water retention and
weight gain.

45. Wrap up
We are amidst an epidemic of
obesity.
Right eating habits
Balance Diet combined with
Right kind of Physical Activity
for age/ sex are the only
saviors
Eat with Awareness-why, what,
when, where, how much