*Diet assessment methodologies
*Strategies for diet modification
*Clinical status of herbals, botanicals, and modified food products
*Preventing common diseases such as cardiovascular disease, diabetes, osteoporosis,and breast cancer through nutrition
*Importance of genetic factors
*Understanding of cultural and socio-economic influences on eating and exercise behaviors and integrating that knowledge with biological or functional markers of disease
This reference addresses basic principles and concepts that are central to the major clinical nutrition-related activities, such as nutritional assessment and monitoring, current theoretical base and knowledge of efficacious interventions, interactions between genetic and nutritional factors, and the use and interpretation of population-based or clinical epidemiological evidence.
Author Biography: Ann Coulston, American Dietetic Association
Cheryl Rock, University of California, San Diego, U.S.A.
Elaine Monsen, University of Washington, Seattle, U.S.A.
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About the Author
Ann M. Coulston, MS, RD, has a more than 20-year history of clinical research at Stanford University Medical Center where her research centered on carbohydrate and lipid metabolism, the nutritional management of diabetes, and insulin resistance. She has provided nutrition consultation to the food and healthcare industry, public relations firms, and Internet companies. She is past-president of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) and has been recognized by the American Dietetic Association Foundation for excellence in the practice of clinical nutrition and the practice of research.Carol J. Boushey, PHD, MPH, RD, is an Associate Researcher in the Epidemiology Program of the University of Hawaii Cancer Center and an Adjunct Professor in the Nutrition Science Department at Purdue University. Her research includes dietary assessment methods, dietary patterns, and quantitative methods. At the Cancer Center, she directs the Nutrition Shared Resource. She serves on the editorial board of the Journal of the Academy of Nutrition and Dietetics and the Nutrition Committee of the American Heart Association.Mario G. Ferruzzi, PhD is a Professor of Food Science and Nutrition at Purdue University. His research interests are in the area of phytochemical bioavailability, metabolism and their role in chronic disease prevention. Additionally, he has industrial experience in product research and development. Prior to joining Purdue in 2004, he was a Research & Development Scientist with Nestlé R&D in Marysville, OH and Lausanne, Switzerland. He is a member of the Institute of Food Technologists (IFT), the American Society for Nutrition (ASN), and the American Chemical Society (ACS).
Read an Excerpt
From Chapter 1: Dietary Assessment Methodology
I.INTRODUCTION This chapter reviews the major dietary assessment methods, their advantages and disadvantages,and specific issues to consider when collecting these types of data. The intent is for this chapter to lead to an understanding of alternative dietary assessment methods so that the appropriate method is chosen for a particular need. This chapter updates the "Dietary Assessment Resource Manual". II.DIETARY ASSESSMENT METHODS A.Dietary Records For the dietary record approach,the respondent records the foods and beverages and the amounts of each consumed over 1 or more days. The amounts consumed may be measured, using a scale or household measures (such as cups, tablespoons), or estimated, using models, pictures, or no particular aid. Typically, if multiple days are recorded, they are consecutive, and no more than 3 or 4 days are included. Recording periods of more than 4 consecutive days are usually unsatisfactory, as reported intakes decrease because of respondent fatigue. Theoretically, the recording is done at the time of the eating occasion, but it need not be done on paper. Dictaphones, computer recording, and self-recording scales have been used [3-5] and hold special promise for low-literacy groups and other difficult-to-assess populations because of their ease of administration and potential accuracy,although tape recording has not been shown to be useful among school-aged children .
To complete a dietary record, the respondent must be trained in the level of detail required to adequately describe the foods and amounts consumed, including the name of the food (brand name, if possible), preparation methods, recipes for food mixtures, and portion sizes. In some studies this is enhanced by contact and review of the report after 1 day of recording. At the end of the recording period, a trained interviewer should review the records with the respondent to clarify entries and to probe for forgotten foods. Dietary records can also be recorded by someone other than the subject. This is often done with children or institutionalized individuals.
Table of ContentsSection I: Basic Principles and Concepts
Examining the Relationship between Diet, Nutrition and Disease:
Dietary Assessment Methodology.
Energy Requirement Methodology.
Overview of Nutritional Epidemiology.
Analysis, Presentation, and Interpretation of Dietary Data.
Current Theoretical Bases for Nutrition Intervention and Their Uses.
Nutrition Intervention: Lessons from Clinical Trials.
Tools and Techniques to Facilitate Eating Behavior Change.
Evaluation of Nutrition Interventions.
Biomarkers and Biological Indicators of Change.
Genetic Influence on Nutritional Health:
Genetic Influences on Blood Lipids and Cardiovascular Disease Risk.
Genetics of Human Obesity.
Genetic Influence on Cancer Risk.
Inborn Errors of Metabolism.
Supplements and Food Replacements:
Role of Liquid Dietary Supplements.
Composite Foods and Formulas, Parenteral and Enteral Nutrition.
Herbs and Other Botanical Supplements: Principles and Concepts.
Section II: Disease-Specific Intervention: Prevention and Treatment
Dietary Macronutrients and Cardiovascular Risk.
Other Dietary Components and Cardiovascular Risk.
Nutrition, Diet & Hypertension.
Nutrition and Congestive Heart Failure.
Cancer Prevention and Therapy:
Nutrition and Breast Cancer.
Nutrition and Colon Cancer.
Nutrition and Prostate Cancer.
Nutrition and Lung Cancer.
Nutrition and the Patient with Cancer.
Obesity and the Risk for Diabetes.
Nutrition Management for Type 1 Diabetes.
Nutritional Management of Type 2 Diabetes.
Nutrition Management for Gestational Diabetes.
Overview of Treatments and Interventions.
Role of Physical Activity.
Micronutrient Intake and Body Weight.
Behavioral Risk Factors for Obesity: Diet and Physical Activity.
Role of Taste and Appetite in Body Weight Regulation.
Nutrition in the Prevention and Treatment of Common Gastrointestinal Symptoms.
Nutrient Considerations in Lactose Intolerance.
Nutrient Considerations in Inflammatory Bowel Disease and Short Bowel Syndrome.
Nutrition and Liver Disease.
Other Major Diseases:
Nutrition and Renal Disease.
Nutritional Management of Parkinson's Disease and Other Conditions Like Alzheimer's Disease.
Eating Disorders: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder.
Nutrition and Food Allergy.
Nutrition and Cystic Fibrosis.
Nutrition and Immunodeficiency Syndromes.
Disease Prevention Strategy:
Nutrition Guidelines to Maintain Health.
What People are Saying About This
This is a clearly-written, up-to-date review of nutrition and disease. The value of the work is in the review-article style in which various topics are covered and in the coverage of current, on-going research in nutrition and health.
(Tim Byers, MD, MPH, Department of Preventive Medicine and Biometrics, University of Colorado)
The editors have put together a highly readable, well organized and informative text covering a wide range of clinical nutrition topics, which is no mean feat for such a broad interdisciplinary field. I found the information to be well organized. The chapters follow the same general outline and specific data are, therefore, easy to find. The figures are clear and the appendices are informative.
(Robert M. Russell, M.D.)
The purpose of this text is to provide an update of current knowledge in clinical nutrition and an overview of the rationale and science base of its application to practice in the treatment and prevention of disease. The text addresses basic principles and concepts that are central to the major clinical nutrition-related activities, such as nutritional assessment and monitoring, current theoretical base and knowledge of efficacious interventions, interactions between genetic and nutritional factors, and the use and interpretation of population-based or clinical epidemiological evidence. The various roles of clinical nutrition and current knowledge of nutrition in the prevention and treatment of major disease-specific conditions are also reviewed, with an emphasis on past and current scientific evidence that supports these roles. New areas of interest and study are also discussed, with the perspective that the application of the scientific method is by definition an evolutionary process.
Treatment of the disease diabetes mellitus provides an excellent and current example of treatment evolution. In the early part of the 20th century, before the discovery of insulin by F.G. Banting and C.H. Best in 1921,the treatment of choice for individuals with diabetes mellitus was morphine for pain abatement along with a very restricted, starvation diet. When insulin injections became available, dietary protocols were developed. Initially, dietary treatment was based on food exchange lists that encouraged prescribed intakes of carbohydrate, protein, and fat. Recent research from the Diabetes Control and Complications Trial and a similar research trial inthe United Kingdom has been the base for the current dietary management emphasizing blood glucose monitoring throughout the day and individualized adjustment of carbohydrate ingestion and insulin injection in individuals who require insulin therapy. Nutrition intervention plays a major role in the management of the patient with diabetes mellitus and in the treatment of the disease and the prevention or delay of complications (see Part II.C).
Another essential role for nutrition intervention is in the prevention of cancer. Cancer represents a disease continuum and at all stages, from primary prevention to treatment, nutrition is a key factor. As discussed in the section highlighting nutrition and major cancer types, an explosion of new knowledge has identified nutrition as a major factor in the etiology and progression of disease (see Part II.B).
Nutrition is the process by which the human body utilizes food for the production of energy, for the maintenance of health, for growth, and for the normal functioning of every organ and tissue. Clinical nutrition is the study of nutrition and diet as related to the development and treatment of human disease. Nutrition is an interdisciplinary field of study, built on a foundation of biomedical and behavioral sciences. Clinical nutrition is the aspect of nutrition science that is related to the development, progression, or management of disease, as differentiated from the issues of normal requirements, cellular functions and activities, and various topics that must be addressed in meeting basic requirements to enable normal growth and development.
Areas of study that contribute to knowledge in clinical nutrition include the disease-relevant biochemistry, metabolism, and activities of nutrients and dietary factors within the tissues and cells; the bioavailability and utilization of nutrients from various food sources, as disease risk or diagnosis may influence these factors; the regulation and compartmentalization of nutrients in the body; the attitudes about food and the eating patterns and behaviors of the targeted individual or group; the technology of food science and specialized or modified food products; and the technology involved in providing adequate and appropriate nutrients or foods to individuals and various community-based or institutionalized groups. Other aspects of clinical nutrition include the development and evaluation of nutrition education efforts; the development of nutrition policies, guidelines, and practice standards that affect the goals and objectives of government and private health agencies, professional practice groups, and health-related organizations; and the design and implementation of individual, clinical, and community-based nutrition and diet interventions. Clinical nutrition interventions range in scope from efforts to maintain health during short-term illness, to optimization of health status in individuals at risk for or diagnosed with chronic diseases, to major nutritional and diet modifications as specific or adjuvant treatments for disease. Clinical nutrition encompasses primary, secondary, and tertiary disease prevention, in addition to management of disease.
Dietary intake or nutritional status may be altered as a result of disease or by the treatment modalities that are utilized, such as surgical treatments, or medical management strategies, such as drugs. The altered needs must be met by dietary or nutritional interventions in order to prevent malnutrition and the associated consequences, which would contribute to overall morbidity and mortality. Also, nutrition intervention can be a critical component of disease prevention, an important aspect of disease management, or the primary treatment for disease. A complicating factor is that people generally eat food, rather than nutrients, so that the practical and psychosocial aspects of diet modification and food or food product availability must be considered in any nutrition intervention, whether individual or community based, and irrespective of whether the goal is primary prevention or disease treatment.
As in any area of the biomedical sciences, the importance of science-based activities and practices cannot be understated. Clinical nutrition concepts and practices that can become popular with either the lay public or professionals are sometimes based on the type of scientific evidence that cannot truly support the rationales and practices, regardless of how standard and common they might be. Popular theories may be generated by observational epidemiological studies, case series, or anecdotal reports, all of which lack the capability of truly demonstrating a causative or efficacious role for the nutritional factor. Such studies are useful for generating hypotheses, but the apparent associations between diets and disease may be confounded by uncontrolled or unmeasured factors and other determinants of health and disease. Unproven diet therapies exist for the treatment of numerous conditions, and many aspects of common nutrition interventions are sorely in need of testing in an appropriate research design. As in any other aspect of disease prevention and treatment, the use of nutrition interventions or diet therapies should be based on a scientific rationale and sound data, not on anecdotal experience. The scientific basis for clinical nutrition needs to expand considerably in order to fully support claims for the efficacy of many of the common activities and interventions, and progress in this area is being made.
Our definitions of diseases need to further evolve to bring greater clarity and improve precision of treatment. As gene-diet interactions are scientifically delineated, laser-sharp therapies may be applied to specific individuals. For the public, however, generating and analyzing data that summarize dietary intake and its association with disease will be valuable tasks in both treating disease and developing disease prevention strategies. Well-designed focused screening will be an aid in disease detection, and well-founded medical nutrition therapies can minimize disease development and related complications. Providing scientifically sound, creative, and effective nutrition interventions can be challenging. In so doing, however, we will serve the public good. It is our goal to update our knowledge and its application through updated editions of this text. In addition, we plan to provide online access to relevant new findings and their import to nutrition in the prevention and treatment of disease. It is our goal to raise the bar for both understanding and treatment.