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A healthy diet in infancy and childhood must not only support normal growth and development, but is also the foundation of adult health. Optimum nutrition and good feeding of infants and children are among the most important determinants of their health, growth and development. A healthy diet prevents malnutrition and early growth retardation, which are common in some parts of the world. Poorly fed...
Several ecological, case-control and cohort studies indicate that diets rich in plant foods provide protection against cardiovascular disease, several common types of cancer and other chronic diseases. However, despite the consensus of the evidence about the health effect of plant foods, it is still unclear which components of plant-based foods are protective and what their mechanism of action is...
Research suggests that to classify overweight individuals accurately with respect to health risks, both BMI and an indicator of fat distribution must be considered. Obesity is prevalent in countries with established market economies and is increasing. Obesity is usually more common in those of low socioeconomic status. It is a major contributor to total healthcare costs in affluent societies. Here...
The epidemic of obesity is already having major effects on population health. Obesity develops in an individual when energy intake exceeds energy expenditure over a long period. The biological processes regulating energy balance are very tightly regulated. Control pathways include short-term signalling of hunger and satiety with hormones derived from the gastrointestinal tract to the central nervous...
Malnutrition generally implies undernutrition and refers to all deviations from adequate and optimal nutritional status in infants, children and in adults. In children, undernutrition manifests as underweight and stunting (short stature), while severely undernourished children present with the symptoms and signs that characterize conditions known as kwashiorkor, marasmus or marasmic-kwashiorkar. The...
Metabolic syndrome describes the co-existence of several major risk factors for cardiovascular disease (CVD) – hyperglycaemia, high blood pressure, and dyslipidaemia (low high-density lipoprotein cholesterol, high triglycerides) which appear to be aetiologically linked, probably by genetic factors. The appearance of the metabolic syndrome phenotype is provoked by weight gain, and specifically by intra-abdominal...
Obesity now represents one of the most important global public health issues through its rapidly increasing prevalence and association with a wide range of diseases. Mortality is increased with increasing BMI and a 40-year old with a BMI >30 kg/m 2 might expect to die 6–7 years earlier than a normal weight individual. There is a strong link of type 2 diabetes with obesity – a 25% increase...
Obesity is an increasing problem worldwide. Dieting and available medications are relatively ineffective, especially for the morbidly obese. However, bariatric surgery has been shown to provide long lasting reduction of obesity related non-insulin dependent diabetes mellitus, hypertension and hyperlipidaemia. Furthermore, longevity was improved. Motivated patients of BMI greater than 40 (or 35 with...
Interest in the impact of nutritional factors on the aetiology of disease has tended to deflect some attention away from the impact of a wide range of diseases on nutritional status. Diseases can affect all aspects of nutritional status: appetite, food consumption and diet quality (‘what we eat’); body and tissue composition (‘what we are’) and capacity to utilize and metabolize nutrients (‘what we...
Modern weight management incorporates optimization of health and risk factors, short-term weight loss, and long-term weight maintenance and prevention of regain. Patients in need of professional weight management can be identified by a large waist (>102 cm for men, >88 cm for women). A structured programme addressing diet and physical activity, and behavioural management, as used in the UK Counterweight...
The last few years have seen what may be looked back on as the dawn of a new era in cancer therapy. Biological agents (those which target specific molecular abnormalities in cancer cells) as opposed to the more conventional chemotherapy, radiotherapy or hormone therapy, have at last begun to show the first signs of benefits in randomized clinical trials. So far the size of the benefit has, on the...
Recent decades have seen dramatic improvements in our ability as a profession to care for patients with critical illness and chronic disease. One consequence of this is that patients now more often survive to a point where nutrition becomes a limiting factor in their care. In addition, we now have the skills and technology to maintain a patients’ nutritional status indefinitely. Taken together, these...
Undernutrition is common in hospitalized patients and should be detected by routine nutritional screening on admission. Nutritional requirements can be estimated by an expert dietitian and decisions to supplement hospital diet or to supply completely artificial nutritional support should be made based on whether intake is adequate and the gut functioning. If possible enteral nutrition is preferred...
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