Unit 2 - Lecture notes 2 PDF

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Unit 2: Nutrition Guidelines and Application… Learning Objectives Upon completion of Unit 2 you should be able to: 1. Describe the types of nutrient intake recommendations included in the Dietary Reference Intake standards 2. Access Health Canada’s website to become familiar with Canada’s Food Guide recommendations *Note as of this year, there is a NEW Canada's Food Guide. Please refer to the Unit notes, not your text which describes the OLD CFG. 3. Identify nutrition-related claims that Health Canada allows on food labels 4. Describe the various ways in which we evaluate nutritional status and discuss the pros and cons of different nutrition assessment tools Dietary Reference Intakes o

Using the research methods discussed in Unit 1 and Chapter 1, nutrition scientists have been able to estimate the amount of each nutrient required by the body to ensure optimal health, prevent deficiencies, and maintain a healthy pregnancy. Overt nutrient deficiencies are now rare in Canada, but the incidence of diet-related chronic diseases such as type 2 diabetes, cardiovascular disease, obesity, and cancer has become a major public health concern.

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Dietary Reference Intakes (DRIs): are a set of reference values for energy and nutrient intake for Canada and the United States. The DRIs are used to plan, promote, and assess the diets of healthy individuals, so they do not apply to those who are ill or have adverse conditions or diseases (for example: anemia, type 2 diabetes, Crohn’s disease).

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A few important points to keep in mind about the DRIs: o The DRIs are not necessarily to be consumed every day, but should be consumed on most days, that is, an average intake. o The values are based on different life-stage groups: infants, children, adolescents, adults, older adults, and pregnant and lactating women. They also take into consideration gender (male vs female). o The DRIs can be thought of as an “umbrella term” for macro- and micronutrients listed in different sets of values and you should be familiar with the following as described in your text: 1) Estimated Average Requirement (EAR): 2) Recommended Dietary Allowance (RDA); 3) Adequate Intake (AI): used as a goal when there isn’t an RDA 4) Tolerable Upper Intake Level (UL); and for macronutrients the standards include Acceptable Macronutrient Distribution Ranges (AMDRs) and Estimate Energy Requirements (EERs).

Canada’s Food Guide

Canada’s Food Guide (CFG) translates nutrition science into practical guidelines by providing a set of dietary recommendations to promote health and reduce chronic disease risks in the Canadian

population. Unlike DRIs, which provide specific recommendations for amounts of nutrients, Canada’s Dietary Guidelines suggest overall diet (food) and lifestyle choices. They suggest a pattern of food choices incorporating the foundations of a healthy diet: variety, balance, and moderation.

Canada’s Food Guide has two parts: 1) The rainbow side places foods into four groups: fruits and vegetables, grains, milk and alternatives, and meat and alternatives. Note: the largest arc of the rainbow represents where the largest number of food servings should come from 2) Recommendations for number of servings per day are based on gender and age. In order to make every food guide serving count, CFG recommends food choices be low in fat, low in sugar, low in sodium, and high in fibre. They also recommend water as the beverage of choice for Canadian’s to quench their thirst and educate Canadian’s on reading food labels to assist in making better food choices. Please visit Health Canada’s website and your text for a more detailed description and to familiarize yourself with Eating Well with Canada’s Food Guide (https://www.canada.ca/en/health-canada/services/canada-food- guides.html). Eating Well with Canada’s Food Guide for First Nations, Inuit, and Metis was developed to recognize the cultural values and combination of both traditional (meat, wild game, fish, wild plants) and store-bought foods often consumed by aboriginal people. Visit Health Canada’s website and familiarize yourself with this food guide (Available online at https://www.canada.ca/en/health-canada/services/foodnutrition/canada-food-guide/eating-well-with-canada-food-guide-first-nations-inuit- metis.html). Health Canada permits certain nutrient content claims to be used on food labels. You should be familiar with these descriptors commonly used on food labels. Below is a sample, but there are more described in your text: Food Labels and Nutrition Facts Labels are another helpful tool for consumers that allow us to make informed choices about the food we eat by providing an abundance of information, including the product name, name and address of the manufacturer, net contents (weight, measure, or count), ingredients (in order of predominance by weight), and nutrient contents. The Nutrition Facts of a food label provide detailed information about the nutrient contents in a serving of a food product. All Nutrition Facts labels have mandatory information that must be provided to the consumer as shown below. Percent Daily Va ht-hand side of a Nutrition Facts panel that helps a c ect healthier foods based on nutrient content. D average, healthy person consuming 2000 kcal daily.

Health Canada permits certain nutrient content claims to be used on food labels. You should be familiar with these descriptors commonly used on food labels. Below is a sample, but there are more described in your text: o Sugar free – product must contain < 0.5 g of sugar per serving o Low calorie – the food must supply 40 kcal or less per serving o Fat-free – the food must provide < 0.5 g of fat per serving o Low fat – the food must contain 3 g or less fat per serving o Lean – used in meat and poultry – the food contains ≤ 10% of fat o Extra lean – used in meat and poultry – the food contains ≤ 7.5% of fat Nutrition Assessment As mentioned previously, scientists have developed standards for the amounts of nutrients we should consume (DRIs) and tools we need to plan a healthy diet to meet these needs (CFG). But how do we know if the nutritional needs of an individual or population are being met? Nutritional assessments allow us to determine the nutritional status of individuals or population groups (nutrient deficiency or excess) to determine nutritional needs and plan programs (individual or community-based such as school breakfast program or meal plans for nursing home residents) to meet those needs. Estimating Nutrient Intake - Recordkeeping You should be familiar with the following methods for recording and assessing dietary intake in addition to common challenges associated with each method:

Common Challenges Overall: o Patient is unable to recall exactly what they consumed o Under- and overestimation of portion sizes consumed – more often than not, people will underestimate their food intake! o Weekend food intake often differs from food consumed during the week Lack of commitment to recording intake o Intake reported is not a “typical” day (e.g. patient was sick, participant was o carbohydrate loading to compete in an upcoming sporting event, etc.) Analyzing Nutrient Intake – to get a general snapshot, individual nutrient intake can be compared to recommended intakes. We can analyze nutrient intake through basic tools such as Canada’s Food Guide (categorizing food items based on serving amounts and food groups) and through more sophisticated programs such as EaTracker (a free program created by Dietitians of Canada) or iProfile (a more comprehensive food software program you will use with your text). In addition to nutrient intake, information about an individual’s physical health is often needed to determine nutrient intake. This is often in the case of a deficiency and may include: o Anthropometric measurements (height and weight) o Medical, health history, and physical exams (health status, disease risk factors, family medical history) o Laboratory measurements (assess nutrient levels in blood or urine samples) Terms Dietary Reference Intake o Provide dietary assessment and planning guidance for individuals & groups (populations). o Determine estimates of upper intake limits o DRIs are set for nutrients: o 1) that are found in food. o 2) that have an essential, identifiable, biological function. o 3) for which the levels required for tissue homeostasis and normal function in humans are known. EAR o the daily intake estimated to meet the requirement of 50% of the people in a specific age and gender group (the average amount of a nutrient that appears sufficient, or adequate, for half the population). o evaluate individual nutrient needs and plan nutrition programs for meet groups’ needs. AI o an estimate of the average nutrient intake by a population of healthy people; used when not enough information is available to set EAR / RDA (no scientific evidence) (there will never be an AI when there is a set EAR/RDA). o The value is based on scientific judgement (comparable to RDA but based on less scientific evidence). UL o the level of daily nutrient intake that is not likely to create adverse health effects

in 97.5% of the people in a specific age and gender group; an amount that can be biologically tolerated with no apparent risk of adverse effects by almost all healthy people. o UL is a ceiling or maximum level used to guard against overconsumption. life-stage group AMDR o Acceptable macronutrient distribution ranges (AMDRs) o AMDRs have been set for carbohydrates, fats, proteins o Expressed as a % of total energy intake o A range of intakes that is associated with a reduced risk of chronic disease (yet provides adequate amounts of essential nutrients) o Compared to the RDA and AI values, recommendations for energy are not generous o Based on a reference height and mass for men and women o FAT AMDR: 20-35% o CARBOHYDRATE AMDR: 45-65% o PROTEIN AMDR: 10-35% EER...