The relationship between diet and disease is a complex and multifaceted one, influencing not only our physical health but also our mental well-being. More and more healthcare professionals are recognizing the powerful connection between nutrition and chronic disease prevention, reinforcing the concept of food as preventive medicine. Optimal nutrition is imperative to human health. Research shows that an unhealthy diet is one of the major risk factors for a range of chronic diseases, including diabetes, cancer, cardiovascular diseases, and other conditions linked to obesity (World Health Organization, 2022).
Unraveling the Historical Perspective
In the 1970s, researchers observed that cancer rates varied significantly across different countries, even after accounting for biological differences between populations. This led to the hypothesis that environmental factors, particularly diet, might be responsible for these variations. Based on this evidence, dietary guidelines emphasized reducing fat intake. However, subsequent studies revealed that the association between dietary fat and cancer rates was not consistent. Rigorous research in the 1990s and early 2000s directly compared individuals who reduced their fat intake with those who did not, finding no significant link between overall dietary fat and cancer risk. Further investigations into specific types of dietary fats indicated that trans and saturated fats increased disease risks, while unsaturated fats did not.
The Preventative Power of Nutrition
The food we consume daily provides nourishment and fuel for our bodies, and it also significantly impacts our long-term health. Research published in Nutrients highlights that dietary choices can contribute to various chronic health conditions, including obesity, type 2 diabetes, cardiovascular disease, metabolic syndrome, and certain cancers. Eating patterns in the United States often deviate from recommended dietary guidelines, contributing to an increase in chronic illness. It’s important not to confuse preventive nutrition with fad diets.
Systemic inflammation can increase the risk of several chronic diseases, including obesity, type 2 diabetes, heart disease, and inflammatory bowel disease.
Established Dietary Patterns for Health
There are several established dietary patterns that offer proven health results, such as the Mediterranean diet. By emphasizing healthy eating patterns, good fats, and plant-based nutrition, this diet can help support a healthy weight and lower the risk of heart disease. For example, people with prediabetes or type 2 diabetes may benefit from a low-glycemic diet, which centers on foods that cause a slower, more gradual increase in blood sugar. Another nutritional plan that can help reduce high blood pressure and cardiovascular disease risk is the DASH diet plan. This plan explores the connection between diet and heart disease, prompting individuals to prioritize fiber-rich meals to support heart health.
Read also: The Hoxsey Diet
The Importance of Dietary Counseling
Although patients of all ages can benefit from dietary counseling, it’s particularly helpful to those who are at high risk of developing one or more chronic diseases. Before providers can implement dietary counseling strategies, they first need to evaluate the patient, including their dietary risk factors and readiness for change. Making dietary changes can be incredibly difficult, especially due to the social and emotional connection that many people have with eating. Once a healthcare provider has evaluated their patient and determined that they are ready for ongoing nutritional counseling, they must collaborate to set realistic, personalized goals. One effective framework is the SMART goal model, which stands for Specific, Measurable, Achievable, Results-focused, and Timely. To deliver the best possible results, healthcare providers should partner with nutrition counselors and create personalized guidance for their patients. Patients are most likely to resist change when they feel forced to commit to healthy eating habits that they will not enjoy. Meal planning resources and other visual aids can be powerful tools for those looking to change their habits and adopt a new dietary pattern.
Modern Approaches to Nutrition
The U.S. Department of Agriculture (USDA) has replaced the outdated food pyramid with more comprehensive dietary guidelines. Nutrition tracking apps and other digital tools have become particularly popular among those looking to prioritize nutrition and adopt healthy eating habits. Food has long played a pivotal role in cultural traditions, requiring nutrition counselors and healthcare providers to consider cultural dietary preferences. By tracking health indicators, healthcare providers and nutritional counselors can see the short-term and long-term impacts of dietary changes. Helping patients stick with their dietary plan requires continued support and practical strategies. As the link between nutrition and health becomes more widely understood, professionals across healthcare are seeking tools to provide holistic, patient-centered care.
Addressing Diet-Related Health Disparities
Diet-related chronic diseases disproportionately affect underserved communities, exacerbate health disparities, and are directly related to diet-related chronic diseases. Evidence-based policy solutions are greatly needed to foster an equitable and climate-smart food system that improves health, nutrition and reduces chronic disease healthcare costs. In light of these challenges, a policy analysis was conducted to prioritize policy options and implementation strategies to address diet-related chronic diseases and nutritional health disparities. Final recommendations were issued for bipartisan consideration in the 2023-24 Farm Bill Reauthorization.
The Farm Bill and Nutritional Equity
Initially designed in 1933 to address agriculture, the Farm Bill has evolved to support the affordability of healthy foods. Significant milestones include the Food Stamp Act of 1964, which provided financial assistance for food security and evolved into the Supplemental Nutrition Assistance Program (SNAP). SNAP is a federal food assistance program that provides monthly benefits for approximately 40 million low-income Americans, primarily children, older adults, and individuals with disabilities. Effective SNAP implementation must emphasize nutrition equity to reduce diet-related health disparities among low-income Americans. Lower-income communities often consume greater amounts of ultra-processed foods (UPF) due to their longer shelf life, wide accessibility, and lower costs, making them a convenient option for food-insecure households and a continuous driver of diet-related chronic disease. Low-income communities are highly targeted by UPF supply chains and are subject to aggressive marketing.
The Food Insecurity Nutrition Incentive (FINI), expanded from 2014, supports improved agricultural management of specialty crops such as fruits, vegetables, dried fruit, and tree nuts. SNAP comprises the majority of federal nutrition assistance expenditures, providing EBT benefits to low-income households, individuals, and families to purchase food at SNAP-authorized retailers.
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The White House National Strategy on Hunger, Nutrition, and Health
The White House held its first food policy conference on this topic in over 50 years. The federal government’s bipartisan multisector plan to reduce diet-related diseases, improve nutrition, fight hunger and food insecurity, and reduce health disparities comprises five pillars. To support this national strategy, a policy analysis was performed to formulate options and recommendations for further consideration in this year’s 2023-24 Farm Bill Reauthorization. The goal is to identify policy options that promote a healthy, equitable, climate-smart, sustainable food system and reduce diet-related chronic disease.
Policy Analysis Framework
A policy analysis was conducted using the Centers for Disease Control and Prevention’s (CDC) Policy Analysis Framework tool. The CDC plays a significant and non-biased role in analyzing policy options for public health problems through the lens of health, economic, and budgetary impacts. The CDC policy analytical framework aims to strengthen local communities through national-level policy analysis and strategy planning processes. The project completed the first three structured domains of the CDC Policy Analysis Framework: problem identification; policy analysis and assessment; prioritization of available options; and final policy recommendations for implementation.
Key Insight Areas for Policy Development
The policy analysis focused on several key insight areas, including sugar-sweetened beverages, food insecurity, reducing UPFs by incentivizing healthy F/V from environmentally sustainable climate-smart agriculture sources, and prioritizing and expanding “food as medicine” nutrition prescriptions. Final policy recommendations and implementation strategies were described in accordance with the evidence.
Sugar-Sweetened Beverages (SSBs)
Sugar-sweetened beverages include regular soda, fruit drinks, sports drinks, energy drinks, sweetened waters, and sweetened coffee and tea drinks. According to the 2020-2025 Dietary Guidelines for Americans, added sugars should be limited to less than 10% of daily caloric intake. High SSB consumption is linked to increased body mass index and obesity, preventable death/disability, and global diet-related chronic diseases such as T2D and CVD. SSB consumption is higher in males, young adults ages 20-39 years, non-Hispanic Black individuals and Mexican Americans, and adults with low incomes below 130% of the poverty line. Although SSB consumption trends decreased over time, they remained the most significant source of added sugar intake at 37% in 2017-2018. Consumption of artificially sweetened beverages (ASBs) is also associated with developing T2D, CVD, obesity, hypertension and all-cause mortality; however, more scientific evidence is needed to understand conflicting associations, effects strengths and possible carcinogenic impacts at high doses.
Food Insecurity
Food-secure households maintain consistent food access for a healthy and active lifestyle. A significant percentage of U.S. households were food insecure, demonstrating increased vulnerability during times of economic disruption and uncertainty. Low food security leads to disruptions in eating patterns and a need for federal assistance such as SNAP benefits, while very low food security results in disrupted patterns and reduced food intake. Food insecurity is linked to additional healthcare from skipping and delaying medications and healthcare visits, further perpetuating the problem of poor health. Food insecurity demonstrates well-characterized rural and urban geographic, regional patterns with disproportionate impacts on high poverty counties with African American, Alaska Native/American Indian, racial and ethnic minority groups.
Read also: Weight Loss with Low-FODMAP
Current 2024-2034 Congressional Budget Office post-pandemic SNAP projections expect a decrease in participation and cost due to the end of COVID-19 emergency funds supporting additional food benefits to families with children.
Ultra-Processed Foods (UPFs)
UPFs are foods that have undergone multiple industrial production processes, include frequent use of cosmetic additives for longer shelf-life and hyper-palatability, and involve synthetic formulations of energy-dense ingredients including sugar, salt, and trans fats. UPFs are common staples of the “Westernized diet” and are often found in “food deserts” and “food swamps.” Higher UPF intake is associated with higher risks of CVD, T2D, coronary heart, and cerebrovascular disease. To reduce UPFs, harmful production and consumption supply chains must be neutralized, while increasing the availability of minimally processed nutritious foods sourced from environmentally sustainable agriculture and climate-smart farming practices.
Diets lower in animal products generally emit fewer greenhouse gases (GHG) than meat-heavy Western diets. Climate-smart and resilient foods feature diet diversification with whole grains, legumes, fruits, and vegetables sourced from environmentally sustainable food systems, reduced meat sources, and a focus on key energy and nutrient crops. Food and nutrition policy can synergistically advance improvements in both human and environmental health, protecting both key determinants of human welfare.
Food as Medicine
The prevalence and financial burdens of T2D, CVD, and other diet-related chronic diseases have reached epidemic levels, necessitating a multifactorial approach with diet at the center. “Food is medicine” (or produce prescriptions) is an evidence-based policy approach gaining interest and favorable feedback to facilitate consistent use of USDA-DHHS dietary nutrition guidelines in routine healthcare, especially for those with limited access to healthy foods and health insurance coverage. These guidelines, emphasizing greater intakes of whole grains, vegetables, fruits, legumes, and nuts, and lower intakes of processed foods, meat and poultry, and SSBs, can be tailored to reflect a wide variety of cultural preferences and ethnic traditions.
“Food is medicine” interventions typically feature prescriptions based on a person’s unique health, lifestyle, and diet-related disease medical diagnosis requirements that can be linked to insurance reimbursement, care coordination, and case management structures. Specific formats include medically tailored meals (MTM), customized groceries, food insecurity produce prescriptions, precision medicine, precision health, and precision nutrition science. Nutritionally calibrated “food is medicine” interventions continue to show significant promise by empowering patients and caregivers to optimally prevent and manage chronic diseases and related complications.
The Gut Microbiome and its Role
An unhealthy diet can alter the microbiome in the gut, thereby impacting the gut-brain connection and affecting mental health and well-being. Studies have shown that the intake of specific foods or food groups, such as whole grains, vegetables, and red meats, is associated with changes in the abundance of specific genera and species of gut microbiota.
The Role of Nutrition for the Aging Population
The role of nutrition for the aging population has implications for cognition and Alzheimer's Disease. The aging process is often associated with a decline in cognitive function, and Alzheimer's disease is a devastating neurodegenerative disorder that primarily affects older adults.
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