Nutrition and Preventing Non-Communicable Diseases
The future of non-communicable disease (NCD) prevention needs more investment. That is the message from Yach and Calitz in JAMA. They identify 4 areas of focus:
- 1. Conducting more research on the health care costs of preventing NCDs in community settings.
- 2. Increasing NIH support for prevention science generally and providing more resources to the NIH Office of Disease Prevention.
- 3. Stimulating the Foundation of the NIH to accelerate prevention science through private-public research partnerships.
- 4. Developing a framework to ensure acceptance of personalized health technology (similar to that of the National Human Genome Research Institute’s Ethical, Legal and Social Implications Research Program).
We know diet quality affects health. Hubbard and colleagues report that 41% of elementary school children bring lunch to school but only 27% of these lunches met ≥3 of 5 National School Lunch Program standards. 45% bring snacks to school. Only 4% of snacks met 2 of 4 Child and Adult Care Food Program standards. How can a child be well-nourished when parents send them to school with these options?
Kulkarni and colleagues assessed diet quality of 4,249 socially-disadvantaged students (12-20y) living in New Zealand. They used dietary questionnaires in a cross-sectional, population-based survey. Healthy eating behaviors was positively associated with mental health. Healthy eating was defined as: eating breakfast, mid-morning snack and lunch; eating breakfast, mid-morning snack and lunch at home; eating fruits and vegetables; and eating dinner as a family. Unhealthy eating was negatively associated with mental health. Unhealthy eating behaviors included: consuming soft drinks; takeaways; unhealthy snacks (e.g. biscuits, potato chips and instant noodles); fried or high-fat foods (e.g. French fries and pies); sweet foods (e.g. chocolates, lollies and ice cream); and purchasing snacks from takeaways or convenience shops. Both relationships showed dose-dependent relationships.
These studies show diet quality is important. After all, nutritional status depends upon nutrient intake. Nutrients can be ingested as foods or supplements. Just like body weight and blood pressure are measured to see if someone is overweight or hypertensive, blood samples are needed to determine if someone is hyperlipidemic or diabetic. Nutritional status cannot be assessed from dietary records alone. The only way to determine vitamin D status is to measure serum 25(OH)D3 concentrations. And in the case of vitamin D where few foods are naturally rich and fortification regulations are restrictive, supplement use is the best predictor of status.
Advancements in technology are reducing assessment costs and invasiveness. Non-invasive measurement of laser light backscatter from the palm of the hand accurately reflects plasma values and fruit and vegetable intake. Our understanding of the role of nutrients play in preventing NCD will be accelerated by measuring nutrient status and correlating status with functional outcomes.
Yach and Calitz issue a call to action to prevent NCD. Let’s raise our voices with them.
Yach D, Calitz C. New opportunities in the changing landscape of prevention. 2014 JAMA doi: 10.1001/jama.2014.8900
Hubbard KL, Must A, Eliasziw M, Folta SC, Goldberg J. What’s in children’s backpacks: Foods brought from home. 2014 J Acad Nutr Diet doi: 10.1016/j.jand.2014.05.010
Jahns L, Johnson LK, Mayne ST, Cartmel B, Picklo Sr MJ, Ermakov IV, Gellerman W, Whigham LD. Skin and plasma carotenoid response to a provided intervention diet high in vegetables and fruit: uptake and depletion kinetics. 2014 Am J Clin Nutr doi: 10.3945/ajcn.114.086900
Levy MA, McKinnon T, Barker T, Dern A, Helland T, Robertson J, Cuomo J, Wood T, Dixon BM. Predictors of vitamin D status in subjects who consume a vitamin D supplement. 2014 Eur J Clin Nutr doi: 10.1038/ejcn.2014.133
Kulkarni AA, Swinburn BA, Utter J. Associations between diet quality and mental health in socially disadvantaged New Zealand students. 2014 Eur J Clin Nutr doi: 10.1038/ejcn.2014.130