According to the latest statistics from the third National Health and Nutrition Examination Survey, 97 million Americans are overweight or obese.1 The increasing of America’s waistline has dire consequences, such as increased diabetes and heart disease, that rival smoking as a national health problem. Attaining and maintaining health includes diet control and fitness. In September 2002, the Institute of Medicine (IOM) issued new guidelines for diet and exercise.2 This report replaces the previous recommended daily allowances (RDA) established by the Food and Drug Administration in 1973 as a reference for use in nutritional labeling and other regulations involving nutrition components.
The recommended changes are:
- Adults should get 45% to 65% of their calories from carbohydrates, 20% to 35% from fat, and 10% to 35% from protein.
- Acceptable ranges for children are similar to those for adults, except that infants and younger children need a slightly higher proportion of fat (25%-40%). 2
The theory is, if people knew the calorie count of their food choices, they might not eat them! New legislation introduced November 6, 2003 in Congress, called the Menu Education and Labeling (MEAL) bill, would require many restaurants and fast food chains to list calorie counts on menu boards. The law would also require table-service chains (with more than 20 locations) to list calories, saturated fat plus trans fat, carbohydrates, and sodium on printed menus.3 See Figure 1 for calorie counts on some popular food items.
According to one study, most Americans do not receive the recommended amounts of vitamins and minerals on a daily basis and many ingest far too many fats and carbohydrates.4 The study also demonstrated that a low blood level of vitamin C can be strongly predictive of mortality.4
Another nutrient vital to health is folic acid—a B vitamin that the body uses to make red blood cells and other new cells. Folic acid found naturally in food is sometimes called folate. Inadequate amounts of folic acid can increase the risk of anemia, heart disease, colon cancer, and stroke.5 It is vital during pregnancy and conception to prevent some neural tube defects in the fetus. Most people need to have about 400 micrograms (mcg) of folic acid in their diet every day. Pregnant women need 600 mcg a day, but no one should ingest more than 1,000 mcgs per day. Others who may need extra folic acid are: smokers, people who take a lot of aspirin or antacids, and those who take drugs for cancer treatment and for arthritis.5 Visit the March of Dimes Folic Acid Net website at www.folic acid.net/login.asp for more information.
The Skinny on Fats
The issue of fats has been hotly debated and many low fat and nonfat foods are very popular today.6 Although all fats have the same caloric value (9 cal/g), their effects on human health vary greatly. Saturated fat can affect the health of your heart and blood vessels. When the coronary arteries become narrowed or clogged by cholesterol, specifically low density lipoprotein (LDL) and fat deposits, atherosclerosis occurs and the vessels cannot supply adequate blood to the heart. This results in coronary heart disease (CHD).7
Saturated fat is often found in foods from animals. This includes fatty meats, the skin of poultry, and whole-milk dairy products, such as butter, cheese, cream, and ice cream. It also is in coconut, palm kernel, and palm oils. Research has shown that following a healthy eating plan can both reduce the risk of developing high blood pressure and lower an already elevated blood pressure.8
Trans-fatty acids are harmful as well.6 Like saturated fats, trans-fatty acids increase blood levels of LDL cholesterol. Unlike saturated fats, trans-fatty acids reduce levels of high-density lipoprotein (HDL) cholesterol, making trans-fatty acids even more detrimental. Diets high in trans-fatty acids are associated with an increased risk of atherosclerosis and coronary events. Food labels now list the fat, saturated fat, and cholesterol contents of packaged foods. They will soon be required to list trans-fatty acids. Until then, you should check the ingredient list at the bottom of the label for the presence of partially hydrogenated vegetable oils, as these are trans-fatty acids. A tip to remember is that these harmful fats are solid at room temperature.
Unsaturated fatty acids are generally derived from vegetable and marine sources, and are often called oils rather than fats because they are liquid at room temperature. When monounsaturated or polyunsaturated fatty acids are substituted in the diet for saturated fats, blood cholesterol levels fall.6
Omega-3 polyunsaturated fatty acids, such as those in salmon, have also been shown to have a cardioprotective effect.9 Consumption of omega-3 fatty acids is inversely related to the incidence of atherosclerosis and the risk of sudden death. 6
Soy and Fiber
There is much discussion about the addition of soy and fiber to diets. A new study showed that adding soy protein, viscous fiber, and nuts can be as effective for lowering cholesterol as adding a statin drug to a low saturated fat diet.10 The main outcome measures of the study were cholesterol and C-reactive protein levels. Viscous fiber, plant sterols, and almonds had a positive effect on serum fat levels in people with high blood cholesterol through a variety of mechanisms. Dietary recommendations for patients with high blood cholesterol should include foods rich in these items. C-reactive protein is a special type of protein produced by the liver that is only present during episodes of acute inflammation, such as periodontal infection.11 Recently, new studies have suggested that CRP may also be elevated in heart attacks.11,12
Increase Movement = Better Health
In addition to diet, exercise is vital to health, well-being, and weight loss. The IOM recommends that exercise requirements be raised from 30 minutes to 1 hour per day.2 The data clearly show that physically active people maintain their body mass index (BMI) and are more protected against heart disease than sedentary people.2 BMI is a measure of body fat based on height and weight that applies to both adult men and women.13 BMI can be calculated using pounds and inches using online13 tools or with the equation found in Figure 2.
The more intense your level of activity, the less you have to do. All activity counts, such as gardening, housework, walking, or climbing stairs. However, the degree to which they count may vary. For instance, if you keep moving in an aerobics class, that matters more than walking around in the house. As a reference, a total of 1 hour walking at 4 mph meets the requirement, but it does not have to be done at the same time. Actually, it is better to segment your exercise throughout the day with short bursts of physical activity that total up to 1 hour.2
One of the reasons exercise keeps us healthy is its effect on blood sugar levels. Aerobic and weight bearing exercises are both important to overall health and fitness. One study found that resistance training added to aerobic training significantly improved glucose disposal in postmenopausal obese type 2 diabetics.14 Exercise training may improve insulin action through changes in regional adipose tissue deposition, a recognized predictor of risk for Type 2 diabetes and cardiovascular disease. For 16 weeks, 28 obese postmenopausal women with Type 2 diabetes were randomized to receive no training, only aerobic training, or aerobic plus resistance training.16 The combined training group had a significantly greater increase in muscle density than did the group receiving only aerobic training. Thus, resistance plus aerobic training may be more effective for improving insulin resistance than aerobic training alone.
Moderate intensity exercise is as good as vigorous exercise for reducing weight in sedentary women.15 Participants randomized to vigorous exercise intensity did not have greater weight loss than those randomized to a similar dose of exercise performed at a moderate intensity. Moderate and vigorous intensity exercise is equally efficacious for weight reduction and cardiorespiratory fitness in a 1 year supervised weight-loss program with caloric restriction. High duration exercise (200 min/week or more) achieves greater cardiorespiratory fitness but not greater weight loss compared with moderate duration exercise (150 min/week), when combined with a calorie-reduced diet.16
Another item to remember is the effects of diet and exercise on bone health. According to Physician’s Guidelines for the Prevention of Osteoporosis,17 all individuals should obtain an adequate intake of dietary calcium (at least 1,200 mg per day, including supplements if necessary) and vitamin D (400 to 800 IU per day for individuals at risk of deficiency). For a figure to determine your daily calcium rate, visit the web version of this story at: www.dimensionsofdentalhygiene.com. Remember, the skeleton contains 99% of the body’s calcium stores; when the exogenous supply is inadequate, bone tissue is resorbed from the skeleton to maintain blood serum calcium at a constant level.
The guidelines also recommend regular weight-bearing and muscle-strengthening exercise to reduce the risk of falls and fractures.17 Advice should be given to clients to avoid tobacco use and health care professionals should be able to recognize and treat patients with excessive alcohol intake.
As oral health care professionals, we have an obligation to advise clients about health behavior that enhances oral and general wellness. Plus, you want to ensure that you maintain your own health and well-being. Understanding the causes of disease and ways to prevent them is a valuable lesson to learn and impart. The old adage “You are what you eat” has never been more accurate!
- National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: Evidence Report. Rockville, Md: US Dept of Health and Human Services; 1998. NIH publication 98-4083.
- Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Available at: www.nap. edu/books/0309085373/html/. Accessed November 13, 2003.
- Center for Science In the Public Interest. Bill would put nutrition info on restaurant menus. Available at: www.cspinet.org/ new/200311051.html. Accessed November 13, 2003.
- Fletcher AE, Breeze E, Shetty PS. Antioxidant vitamins and mortality in older persons: findings from the nutrition add-on study to the Medical Research Council Trial of Assessment and Management of Older People in the Community. Am J Clin Nutr. 2003;78: 999-1010.
- Cox SR. Folic acid—what’s it all about? J Midwifery Womens Health. 2003; 48(5):365-366.
- Simon HB. What’s new in medicine: diet and exercise. Available at: www.medscape.com/viewarticle/461001. Accessed November 13, 2003.
- National Heart, Lung, and Blood Institute. Coronary heart disease explained. Available at: http://nhlbisupport.com/chd1/chdexp.htm. Accessed November 13, 2003.
- National Heart, Lung, and Blood Institute. The Framingham Heart Study. Available at: www.nhlbi.nih.gov/about/framingham/. Accessed November 13, 2003.
- Hu FB, Bronner L, Willett WC, et al. Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA. 2002;287:1815.
- Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and c-reactive protein. JAMA. 2003;290:502-510, 531-533.
- Medline Plus Health Information. C-reactive protein. Available at: www.nlm.nih.gov/medlineplus/ency/article/003356.htm. Accessed November 13, 2003.
- Riverside Cardiology Associates. C-reactive protein. Available at: www.riversidecardiology.com/archive/10201999.htm. Accessed November 13, 2003.
- National Center for Chronic Disease Prevention and Health Promotion. Body mass index formula. Available at: www.cdc.gov/nccdphp/dnpa/bmi/bmi-adult-formula.htm. Accessed November 13, 2003.
- Cuff D J, Meneilly G S, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26:2977-2982.
- Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W. Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA. 2003;290:1323-1330, 1377-1379.
- McTiernan A, Kooperberg C, White E, et al. Recreational physical activity and the risk of breast cancer in postmenopausal women. The women’s health initiative cohort study. JAMA. 2003;290:1331-1336.
- National Osteoporosis Foundation. Physician’s guide to prevention and treatment of osteoporosis. Available at: www.nof.org/_vti_bin/shtml.dll/physguide/index.htm. Accessed November 13, 2003.