Barasi's Human Nutrition

A Health Perspective, Third Edition

Michael EJ Lean

• Publisher: CRC Press
• Year: 2016
• ISBN:
  9781498776394
• Edition: 3
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Barasi's Human Nutrition: A Health Perspective, Third Edition, provides a comprehensive introduction to the principles and practice of nutrition. Thoroughly revised, restructured, and updated, this new edition presents up-to-date scientific information in an accessible and reader-friendly format, emphasising how important nutrition is for evidence across the full translational health spectrum, from epidemiology and basic sciences through clinical and public heath applications, and ultimately into sustainable public policy.

This third edition places more emphasis on applied nutrition than previous editions. Specifically, sections relating to clinical nutrition, public health nutrition, and improving foods for better health are now separate chapters with new chapters on sport nutrition, obesity, and weight management, and each section has a dedicated table of contents to better highlight the subject covered. The book also focuses on nutritional issues related to globally important, potentially preventable, major diseases, such as coronary heart disease, cancer, and diabetes, and discusses methods for studying nutrition and relevant essential dietary principles for intervention.

This textbook is written from the perspective of experienced teachers at the undergraduate and graduate levels and is an invaluable resource for students in health and nutrition and for those pursuing further qualifications in food science. While containing substantial detail on some interesting topics, this book is written in an 'easy-read' style, which makes potentially complicated subjects accessible to general readers as well as to the more specialised user. It provides both an entry-level introduction to human nutrition for introductory or intermediate undergraduate students and also sufficient comprehensive detail to serve as a reference book for Masters or PhD students.

Section VI

Applied Nutrition

19	Introduction to Public Health Nutrition and Health Promotion

Aims

The aims of this chapter are to

• Review and link some of the issues discussed in earlier parts of the book in relation to increasing health through improved nutrition.
• Consider some of the obstacles to improving nutrition that may exist.
• Describe strategies for health promotion and nutrition education that have been developed in recent years.
• Consider future directions.

To develop and implement policies for the prevention of a disease, it is important at the outset to make a realistic assessment of its prevalence and the extent to which it impacts on morbidity and mortality statistics in the population. Further, if these policies are to relate to dietary intake and nutritional goals, it is also important to make an assessment of the role of the diet in the aetiology of these diseases and how much gain can be expected from changes in the diet.

These are areas of controversy, often generating polarized opinions. At one extreme, it is suggested that, because we cannot be certain that diet plays a role in a particular disease, we should do nothing, with the implication that change could do more harm than good. On the other hand, others suggest changes based on very weak evidence, coming from a small database. However, between these extremes, there is a broad consensus on desirable dietary change, based on evidence from a large number of studies. Many of these have been re-evaluated using the technique of ‘meta-analysis’, which allows a number of studies with similar research criteria to be combined to increase the statistical power of the results.

Since its formation in 1948, the World Health Organization (WHO) has been working to improve the health of all the people of the world. In the last two decades, it has become clear that there have been changes in patterns of morbidity and mortality in many countries. These have arisen from

• Reductions in maternal and infant mortalities
• Better control of infectious diseases through immunization and environmental improvements, although the spread of HIV infection has run counter to this trend
• Increased population life expectancies owing to advances in medical technology and lifestyle changes
• Improvements in diets in some areas

However, in parallel with these, there has been a persistent rise in chronic non-communicable diseases, such as cardiovascular disease, cancers, diabetes, chronic respiratory diseases and osteoporosis. In the Western industrialized countries, these diseases have been well established for over 40 years and, in many of these countries, there have been decreases, especially in coronary heart disease incidence. However, there has been an upward trend in the countries of Eastern Europe and, most notably, in the developing countries.

Many countries whose traditional diet and lifestyle had been associated with a low incidence of non-communicable disease have been experiencing a period of food transition. This is typified by an increased consumption of animal protein and reduction in vegetable protein sources, generally associated with a higher fat intake. In addition, the intake of carbohydrate from starchy staples and minerals and vitamins from vegetables may begin to decrease. This has been noted in Japan, where the prevalence of obesity and coronary heart disease, both previously relatively rare conditions, has begun to increase. Countries such as China and those in South America are also experiencing this trend. In some of the poorer countries in the world, the gradual transition to a more Western diet, accompanied by rapid increasing urbanization and lower levels of physical activity (as well as smoking), is causing a rapid rise in chronic diseases. Because of the greater number of people in these countries than in the developed countries, mortality from chronic diseases has now outstripped on a numerical basis that in the developed world. There is also concern about the spread of overweight and obesity in these countries, and the potential for associated health problems, as has already happened in the industrialized world. These trends have been monitored by the INTERHEALTH programme of WHO, which studies the risk of the major non-communicable diseases in a number of populations around the world, as well as trends in diet and nutrition, and aims to promote and monitor community-based strategies for intervention.

In Europe, the WHO has developed the European Food and Nutrition Action Plan 2015–2020. This is an update to the Action Plan for Food and Nutrition Policy 2007–2012 and establishes a mission to achieve universal access to affordable, balanced, healthy food with equity and gender equality in nutrition for all citizens of the WHO European Region through intersectoral policies in the context of Health 2020. The guiding principles underlying this mission are as follows:

• Reduce inequalities in access to healthy food, as stated in Health 2020.
• Ensure human rights and the right to food.
• Empower people and communities through health-enhancing environments.
• Promote a life-course approach.
• Use evidence-based strategies.

The strategic goal is to avoid premature deaths and significantly reduce the burden of preventable diet-related non-communicable diseases, obesity and all other forms of malnutrition still prevalent in the WHO European Region, which are strongly influenced by social determinants of health and have a profound negative impact on well-being and quality of life. This reinforces the approach inherent in many nutrition policies in that it incorporates concepts of social justice and the importance of fair access to food for all.

The Action Plan stresses the importance of taking integrated, comprehensive action in a range of policy areas through a whole-of-government, health-in-all-policies approach. The key objectives will contribute to improving food system gover...