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hello my name is Hana Mennella and I am
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a registered dietician at Rush
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University Medical Center I'm here today
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just to talk about chronic disease
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prevention and specifically looking at
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different types of healthy lifestyle
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behaviors that individuals can implement
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in hopes of decreasing their risk of
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developing certain types of chronic
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diseases first by starting off over
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one-half of all American adults have
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more than one preventable chronic
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condition and nearly 1/4 of individuals
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in the United States have more than two
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chronic conditions and the presence of
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these conditions do require ongoing
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medical attention and may be associated
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with decreased activities of daily
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living in quality of life many of these
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chronic diseases are actually
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preventable but leading preventable
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chronic disease in the United States
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consists of heart disease and stroke
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cancer type 2 diabetes and various
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respiratory diseases such as COPD there
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are a variety of risk factors that have
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been associated with the development of
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these diseases and the leading ones in
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research have been found to be lack of
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physical activity poor nutritional
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behaviors tobacco use or excessive
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alcohol intake here are a number of the
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various risk factors that I will review
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today during this presentation I'll go
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into more detail in the upcoming slides
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high blood pressure is the first one I'm
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going to start with today so high blood
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pressure has been associated with
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various chronic diseases and high blood
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pressure is considered systolic blood
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pressure over 130 millimeters of mercury
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or a diastolic blood pressure of over 80
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milligrams millimeters per mercury the
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associated chronic diseases with high
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blood pressure consist of heart disease
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and stroke there are a variety of
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different lifestyle recommendations that
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have been proposed to assist with blood
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pressure management first and foremost a
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well-balanced low sodium diet has been
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to impact blood pressure specifically
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for individuals who are sodium sensitive
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we know salt is contains a large
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quantity of sodium so as a result they
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do encourage individuals to limit total
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sodium or salt consumption and they
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encourage individuals to limit salt -
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less than 2300 milligrams of sum of
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sodium per day which comes out to one
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teaspoon of salt
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so they do encourage individuals to aim
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for less than one teaspoon salt but it
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is found in a majority of foods as well
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limiting alcohol intake alcohol has been
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associated with increases in blood
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pressure after consumption maintaining
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regular physical activity level I'll go
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into this further on as well - but the
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goal of 150 minutes of moderate
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intensity activity per week has been
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shown to make positive impacts on blood
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pressure status maintaining a healthy
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weight has been found beneficial as well
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as quitting smoking smoking has a direct
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effect on blood vessels and specifically
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the dilation and constriction of blood
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vessels and by quitting smoking you can
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actually see improvements in blood
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pressure levels the next risk factor I'm
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going to discuss this tobacco use in
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tobacco is recognized as the largest
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preventable cause of death in the United
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States and there are over 48 480,000
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deaths per year associated with tobacco
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use tobacco use is a risk factor for all
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of the five listed preventable chronic
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diseases I have here it adds in that fit
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component of respiratory diseases we do
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not quitting smoking or quitting tobacco
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it's very difficult given the addictive
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nature of the substance and we know that
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with it can be difficult because
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individuals have withdrawal symptoms it
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does cause a stress response and
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individuals often do gain significant
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amount of weight after quitting tobacco
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use a lot of people end up overeating in
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response to the cravings associated with
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the withdrawal symptoms however quitting
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smoking or quitting tobacco use in
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general has been shown to reduce the
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risk of there
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cancers heart disease and stroke within
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a six months to one year following
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cessation the third respecter we're
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going to discuss is obesity obesity
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epidemic in our country continues to
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grow and currently almost 40% of all
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Americans are considered obese there are
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a variety of ways to determine what
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obesity is commonly the body mass index
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is being used as a screen measure for
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obesity we know that body mass index is
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imperfect however because it does not
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take into account age muscle mass fat
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mass gender however it has been shown to
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be a fairly decent representation of
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adiposity specifically once you do get
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into the higher body mass categories
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such as obesity or morbid obesity you
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can use circumference measurements as
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well too and look at those in a variety
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of different ways you can look at skin
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folds thickness - and you use a caliper
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- to differentiate the total quantity of
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fat and muscle in a certain area on your
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body specifically looking at say the
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tricep area you can differentiate
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between fat and muscle and those
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measurements below is very much so our
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assessment limited so say if an
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individual that is assessing the skin
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fold isn't as familiar it might not be
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as accurate of an assessment and also by
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electrical impedance is a assessment
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where they run currents through your
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body and they're able to differentiate
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between muscle and fat stores so these
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are all different tools to be used but
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primarily being used is body mass index
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you know obesity has been associated
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with contributing to a majority of the
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preventable chronic diseases limiting
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respiratory disease from the equation by
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obesity has missus youth heart disease
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stroke cancer specifically with cancers
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it's been associated with increased risk
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of breast cancer endometrial cancer
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colon cancer kidney cancer gallbladder
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cancer and liver cancer but it is a
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complex issue cannot just be solved at
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at one time you have
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to approach a variety of different
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factors in order to to truly impact this
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risk factor so has to start on a
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behavioral level so may be undesirable
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food choices are happening maybe
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physical act inactivity maybe it could
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even be a medication use there are
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certain medications that are associated
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with weight gain such as steroids or
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antidepressants even approaching the
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environment so what type of community
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are individuals living in is a community
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with low access to grocery stores maybe
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there are utilizing more convenience
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stores for their food items which
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oftentimes are more shelf stable higher
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calorie items at those times and we do
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also know that genetics play a role in
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obesity and they could even be linked to
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hunger cues or even food intakes
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just on a genetics however we do know
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that obesity is multifactorial and it
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results in complex interactions so we do
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encourage individuals to adopt a healthy
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eating and physical activity habits just
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because you can't change your genes so
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you do want to make sure that you are
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putting yourself at the best chance of
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combating these olicity genetics as much
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as possible physical activity or
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physical inactivity is the nest next
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risk factor and it has been shown that
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nearly 50% of American adults do not
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meet the guidelines for physical
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activity and what are the guidelines mm
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physical activity guidelines thanks sis
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all american adults should engage in 150
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minutes of moderate intensity activity
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per week
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what is moderate intensity activity that
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can vary from person to person but
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typically we recognize it as those
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activities and walking a dog or garden
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taking at a light level doubles tennis
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or maybe even ballroom dancing so these
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light activities that you can still hold
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a conversation while doing our
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considered moderate intensity vigorous
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intensity these are going to be those
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activities that are challenging in
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nature you have a difficult time
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speaking during that simply because your
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heart
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you're breathing heavy you're going to
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have a difficult time talking during
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these types of activities and the
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physical activity guidelines encourage
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individuals to engage in 75 minutes a
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week of these activities if this is the
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level of activity you're able to
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participate in this could include
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running swimming jump roping dancing in
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a lot other in addition to that but
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those are some examples if you were to
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break say 150 minutes of moderate
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intensity activity down it would come
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out to 30 minutes five days a week of
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moderate intensity activity while her we
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do recognize that some activities better
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than not at the end of the day and this
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activity can be broken up into 10-minute
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intervals say if someone is starting off
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on a new exercise program they want to
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start walking however they're not able
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to walk for more than 15 minutes at a
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time that is okay and maybe that just
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means that activity needs to be broken
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in to smaller timeframes in order to
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meet those 30 minutes 5 days a week and
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really at the end of the day the focus
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is on reducing sedentary time reducing
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the time that you're sitting so many
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studies have shown that people that are
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even unable just to sit for prolonged
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periods of time say they get antsy and
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they need to get up and walk around
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those people have been shown to burn
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more calories just in those light
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activities getting up and limiting the
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amount of time they're sitting then just
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being sedentary however I do need to
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know that an individual is starting a
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new exercise program please seek medical
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clearance prior to doing yourself and
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then lat are one of the last ones is the
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nutrition and of course as a dietitian I
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will spend a little more time in this
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section just because it has been linked
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to a number of chronic diseases and
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nutrition in general has been linked to
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the obesity epidemic as well as blood
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pressure and various other risk factors
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as well - so I do believe they all come
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in full circle and today it has been
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from the undesirable food choices and
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excess alcohol intake has been
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associated with a number of chronic
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diseases looking at heart disease stroke
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cancer in type 2 diabetes specifically
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3/4 of our population has in
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adequate intakes of vegetables fruits
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dairies and healthy oils heart-healthy
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oils which I can go more into later down
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and over half of the population is
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exceeding the total grain and protein
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recommendations and specifically
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choosing the undesirable grains and
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proteins in these categories so rather
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than choosing whole grain options
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individuals are choosing more refined
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options and rather than choosing lean
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proteins they're choosing more high fat
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meats and which are not fitting within
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the recommendations and I'll go into
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more of the recommendations on the next
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slide and then in addition most
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Americans do exceed the recommendations
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for added sugar saturated fat which that
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fat that solid at room temperature that
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has been associated with increased
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cholesterol levels and as well as sodium
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we do know that excess sodium can be
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associated with increasing blood
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pressure levels however there's many
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styles of eating that have been found to
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be beneficial many studies linked
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different eating habits or different
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dietary patterns are beneficial but
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already starter which one is to choose
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and which one is the best for you I'm
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going to be going through 3 different
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diet recommendations however there are
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many many more options these are just
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typically the the largest ones that you
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will see recommended the first one I'm
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going to start by talking about is a
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Dietary Guidelines for Americans
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so these recommendations reflect the
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current research or the current
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nutritional science evidence that
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promotes health prevents chronic
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diseases and helps people reach and
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maintain weight so it's looking at the
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research that's out there and coming up
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with some recommendations based on
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previous studies that have been done
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there are three main recommendations for
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this study however it goes into more
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detail per recommendation I believe it's
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about a 56 page document so it's very
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intensive so I encourage you to look at
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the recommendations and see more details
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associated with it the first
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recommendation consume a healthy eating
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pattern that includes
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all foods and beverages within the
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appropriate calorie level so it's not
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necessarily going to say you cannot eat
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this you cannot drink this never have
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this but taking a step back and
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recognizing Oh
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maybe for Kansas Oded a day may exceed
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in my appropriate calorie level given a
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can of soda could contain anywhere from
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250 to 300 calories so it may exceed
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your appropriate calorie level so taking
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a step back and seeing if the can fit
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into your recommendations a healthy
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eating pattern includes a variety of
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vegetables in all colors fruits
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especially whole fruits trying to avoid
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any type of canned fruits given they are
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often associated with increased added
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sugar grains and making half of those
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grains that you're choosing whole grains
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trying to choose low-fat or fat-free
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dairy products rather than high fat
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dairy products and then choosing a
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variety of protein sources
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ideally choosing lean protein sources
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such as seafood lean meats poultry but
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also being able to incorporate a variety
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of other products such as legumes nuts
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seeds and soy products as well - and
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then a healthy eating pattern limits
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does not avoid it limits saturated fat
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trans fat added sugar and sodium so to
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choose these items in a lower quantity
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just to make sure it's not the primary
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the primary focus of your diet but you
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do want to focus on cutting back on
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saturated fats trans fats sugar and salt
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the second recommendation I'm going to
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review is the Harvard's healthy eating
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plate in the mind plate I do lump these
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together because they are fairly similar
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however they have some slight
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differentiations so what these do is
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they illustrate the food groups included
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in the healthy diet and give you a
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visual of a healthy eating behavior from
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a plate perspective typically in
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practice I find as though these plate
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methods are most applicable at lunch or
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dinner times versus breakfast because it
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can be hard if you do eat a traditional
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breakfast style meal to incorporate
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these food groups however with these
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Styles the food groups that are included
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for all from both of the styles are
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fruits vegetables grains and proteins
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right if you were to go to that look at
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the healthy eating plate it's a little
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difficult right now to see because the
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screen is small but it does break down
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details for each of these sections so
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specifically looking at the vegetables
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that encourage
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is a variety of vegetables trying to
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focus more so on vegetable and limiting
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those high starchy vegetables like
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potatoes and the my clay does not break
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these down but my plate if you do go
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online to choose myplate.gov
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it does provide these recommendations as
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well to another recommendation are
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another thing to keep in mind with the
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differences between these plates is that
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the Harvard healthy eating plate does
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not include dairy on their plate they do
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encourage individual to consume two
00:16:02
servings of dairy a day but they do not
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believe that it has to be done in every
00:16:06
single meal they do encourage adequate
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water intake for hydration purposes and
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when the Harvard plate also includes
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oils in this category and they include
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those heart-healthy mono and
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polyunsaturated fats so those liquids
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that are those oils that are liquid at
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room temperature such as olive oil
00:16:24
canola oil and those various oils they
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encourage to use those versus the
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saturated fat alternatives such as
00:16:30
butter margarine or lard in the last
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diet recommendation I'm going to discuss
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is the Dietary Approaches to stop
00:16:39
hypertension so this is the - diet this
00:16:42
is the diet that's been most associated
00:16:44
with decreasing the risk of hypertension
00:16:46
so this is the hypertension focused diet
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it's been able to have a lot of really
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good findings and reports on on
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improvements and blood pressure results
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it aims to create a heart-healthy eating
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style for life it's another temporary
00:16:59
diet it is an eating behavior for your
00:17:01
life it does not limit certain foods so
00:17:04
similar to the Dietary Guidelines for
00:17:06
Americans it doesn't say you can or you
00:17:08
can't eat certain foods however and it
00:17:11
even breaks it down further than that
00:17:12
because it just essentially provides
00:17:14
daily and weekly nutritional goals so it
00:17:16
doesn't say you need to eat this many
00:17:18
servings alright you don't need to eat
00:17:20
this quantity it's just saying you try
00:17:22
to make it within your your your weekly
00:17:25
and daily goals so this is a breakdown
00:17:29
of how this diet works so you have the
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food and nutrient groups on the left so
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you have your grains your meat and
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poultry your vegetables your fruit ooh
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your dairy your fats your sodium nuts
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and seeds beans and sweets and then on
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the right hand side it recommends the
00:17:44
server
00:17:44
to try to aim for her day so with the
00:17:46
grains they want you to try to aim for
00:17:48
six to eight servings of grains per day
00:17:51
and ideally would they would encourage
00:17:54
you to try to choose whole grains when
00:17:56
possible for meats poultry and fish 6 or
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less servings per day so an another
00:18:01
thing to keep in mind a serving size of
00:18:03
meat is 3 ounces so that's significantly
00:18:06
smaller than the serving size that we
00:18:07
would normally eat in the day so at 6
00:18:09
yes may seem like a lot but typically we
00:18:12
eat about two servings per meal anyway
00:18:14
vegetables four to five servings per
00:18:16
meal fruit four to five servings low-fat
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dairy four to five servings fats and
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oils and so on a sofa so forth nuts
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seeds beans as well as sweets they do
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have a recommendation based on your week
00:18:27
so they want you to try to aim for four
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to five servings of nuts seeds and beans
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per week and 5 or less servings the
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sweets per week okay so there's a lot of
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information from those diets but in
00:18:39
summary what all of these diets have in
00:18:41
common include fruits vegetables beans
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and legumes nuts and seeds different
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types of lean proteins such as fish
00:18:49
poultry or plant-based protein such as
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soy and include low fat dairy products
00:18:54
and heart-healthy fats at the end of the
00:18:56
day those are the foods to try to focus
00:18:58
on limit added sugar such as sweets or
00:19:01
sugary drinks sodium which is found in
00:19:04
fatty or processed meats or high salt
00:19:06
foods and then saturated fat which is
00:19:09
also found in in fatty meats marbled
00:19:13
needs high fat cheese's things like that
00:19:16
as well too and then trying to avoid
00:19:19
trans fats trans fats are associated
00:19:22
with increasing bad cholesterol or that
00:19:24
LDL cholesterol as well as partially
00:19:26
hydrogenated oils which are a component
00:19:28
of trans fats typically these foods are
00:19:31
found in fried items a lot of frying
00:19:33
oils are actually made from trans fats
00:19:36
because they have a higher shelf life
00:19:38
and a lot of pastry products that are
00:19:41
made with lard shortening and those
00:19:43
things may be higher in trans fat as
00:19:45
well
00:19:49
alcohol use is a next risk factor I will
00:19:52
talk about and high intakes of alcohol
00:19:55
are associated with over 200
00:19:58
types of diseases but specifically
00:20:00
looking at the diseases we are talking
00:20:02
about here it's associated increased
00:20:04
risk of heart disease stroke cancer and
00:20:06
type 2 diabetes where what do
00:20:09
individuals need to aim for with alcohol
00:20:11
intake though a low to moderate alcohol
00:20:14
consumption is considered one to two
00:20:16
drinks a day high intakes are considered
00:20:19
over two drinks per day and binge
00:20:21
drinking is considered over five drinks
00:20:24
in one sitting
00:20:25
overall recommended for men to limit
00:20:28
alcohol intake to less than two drinks
00:20:30
per day and for women that's less than
00:20:32
one drink per day so when you're
00:20:34
breaking it down into specific beverages
00:20:36
a 1 12 ounce beer is going to be one
00:20:39
drink a day 1/4 ounce glass of wine is
00:20:42
wandering today so looking at it in that
00:20:45
perspective that they are in different
00:20:48
quantities based on alcohol intake but
00:20:51
overall trying to focus on less than two
00:20:53
drinks a day per men and less than one
00:20:54
drink a day per woman to decrease your
00:20:56
risk of developing these chronic
00:20:58
diseases and last but not least
00:21:00
sunscreen use we do know that inadequate
00:21:05
sunscreen use and excessive sun exposure
00:21:08
is linked to the development of skin
00:21:10
cancer and sunscreen has been shown to
00:21:13
protect the skin from sun's harmful UV
00:21:15
rays overall currently one in five
00:21:19
Americans will develop skin cancer in
00:21:21
their lifetime so it's very important to
00:21:23
make sure that you are adequately
00:21:25
applying sunscreen and choosing the
00:21:27
right kind when doing so so choosing a
00:21:29
broad-spectrum protection one that
00:21:31
protects against both UVA and UVB rays
00:21:34
as well as choosing an SPF 30 or higher
00:21:37
also it's very beneficial to look for a
00:21:40
water resistant brand given the
00:21:42
increased risk rate of sweating in the
00:21:44
warmer summer months as well as possible
00:21:46
water exposure if you're swimming or
00:21:48
anything like that in summary I know I
00:21:53
went through a lot of information in a
00:21:55
short amount of time but one half of
00:21:57
American adults have at least one
00:21:59
chronic condition and many of these
00:22:00
conditions are preventable common risk
00:22:03
factors include high blood pressure
00:22:04
tobacco use physical inactivity obesity
00:22:07
excessive alcohol low
00:22:10
and vegetables high sodium and saturated
00:22:12
fat as well as poor sun safety here are
00:22:16
my resources and thank you for listening
