Nutrition and Oral Medicine (Nutrition and Health)

Chapter 1 / General Health Status 7Lifestyle changes, including weight management, diet modification, and physicalactivity are recommended for management of hypertension (1,15). Diets limited insodium from processed foods, reduced in calories and saturated fat, but adequate incalcium, magnesium, and phosphorous may lower blood pressure (16,17).3.1.5. CARDIOVASCULAR DISEASECVD, the primary cause of mortality in the United States, has been the focus ofnutrition and physical activity intervention trials since the 1940s. Beginning with theFramingham studies in 1967, physical activity was found to reduce the risk of heartdisease, whereas obesity was found to increase the risk (18).CVD is characterized by atherosclerotic disease in the vessels supporting the heart.Associated risk factors include obesity, insulin resistance, hypertension, and dyslipidemia.Prevention and management of CVD targets risk factors and includes reductionof energy intake and increased physical activity (19,20).3.1.6. CANCERCancer, defined as a disease of deoxyribonucleic acid (DNA), is characterized byuncontrolled growth of cells secondary to initiating and promoting factors and failure ofthe body to inhibit the uncontrolled growth. Dietary factors have been associated withinitiation (e.g., aflatoxin, nitrosamines) and promotion (e.g., salt, fat) (1). Obesity andexcessive alcohol intake increase risk of certain cancers. Antioxidants (e.g., vitamins A,C, and E) and folic acid found in fruits and vegetables and vitamin B 12 found in animalproducts are thought to decrease risk of cancer. Dietary recommendations to preventcancer include weight management, moderate energy and fat intakes, and a diet rich infruits and vegetables (21).3.2. Dietary Deficiency and DiseasesDietary deficiencies occur less frequently than dietary excesses in the United States,yet remain a significant public health burden, particularly for vulnerable populations.Poverty and environmental barriers are associated with insufficient food intake, relianceon highly processed foods, narrow food choices, and limited nutrient intakes. Youngchildren and the elderly are particularly vulnerable (22).3.2.1. PROTEIN ENERGY MALNUTRITIONProtein energy malnutrition (PEM) is characterized by weight, stature, or weight forstature indices below the fifth percentile for age. PEM is the result of inadequate energyor protein to maintain weight and support growth. Diets characterized by insufficientenergy and protein are typically deficient in multiple nutrients. The etiology of growthfailure may be multifactorial. In addition to physical signs, individuals with PEM mayexhibit cognitive delays, behavioral problems, and emotional problems secondary toPEM (23,24).Management of PEM includes identification and resolution of the underlying problem(e.g., access to food, dysphagia, food preparation barriers). Provision of appropriate andadequate foodstuff, including a variety of foods from all food groups, vitamin and mineralsupplementation when food acceptance is severely limited, and limitation of energydensebeverages with structured meals and snacks are recommended (22).