CHAPTER 1CHAPTER 1

Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

OVERVIEW OF HEALTHYOVERVIEW OF HEALTHYEATING HABITSEATING HABITS

22Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Role of the Dental HygienistRole of the Dental HygienistIdentify harmful dietary habits that may initiate Identify harmful dietary habits that may initiate

oral diseaseoral diseasePromote health and wellness as a health Promote health and wellness as a health

professionalprofessionalOpportunity to see patients on a more regular basis Opportunity to see patients on a more regular basis

than many other health professionalsthan many other health professionalsSupport interventions initiated by other health care Support interventions initiated by other health care

professionalsprofessionalsIdentify patients needing referral to a registered Identify patients needing referral to a registered

dietitian for complex nutrition needs that may dietitian for complex nutrition needs that may ultimately affect general healthultimately affect general health

33Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Basic NutritionBasic Nutrition

NutritionNutritionProcess by which living things use food to obtain Process by which living things use food to obtain

nutrients for energy, growth, and maintenancenutrients for energy, growth, and maintenance

Essential nutrientsEssential nutrientsSubstance obtained from food that the body cannot Substance obtained from food that the body cannot

produce in sufficient quantities to meet physiological produce in sufficient quantities to meet physiological requirementsrequirements

44Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Classes of NutrientsClasses of Nutrients

MacronutrientsMacronutrientsWater*Water*ProteinsProteinsCarbohydratesCarbohydratesFatsFatsAlcoholAlcohol

MicronutrientsMicronutrientsMineralsMineralsVitaminsVitamins

55Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Basic ConceptsBasic Conceptsof Nutritionof Nutrition

Good nutrition evaluated in context of patient’s:Good nutrition evaluated in context of patient’s:Physiological needs for essential nutrientsPhysiological needs for essential nutrientsNutrient content of the foodNutrient content of the foodCultural or environmental circumstancesCultural or environmental circumstancesPersonal preferencesPersonal preferences

Encourage variety of foods to minimize nutrient Encourage variety of foods to minimize nutrient deficiencies or excessesdeficiencies or excesses

66Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Governmental Nutrition ConcernsGovernmental Nutrition ConcernsPrior to 1977 main concern was nutrient Prior to 1977 main concern was nutrient

deficiencies, e.g., pellagradeficiencies, e.g., pellagraCurrent concern is prevention of chronic Current concern is prevention of chronic

diseases related to dietary intake including:diseases related to dietary intake including:Cancer, stroke, diabetes mellitus, atherosclerosis, and Cancer, stroke, diabetes mellitus, atherosclerosis, and

coronary artery diseasecoronary artery disease

77Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Objectives involving nutrition included in 21 Objectives involving nutrition included in 21 priority areaspriority areasOral health and nutrition objectivesOral health and nutrition objectives

Reduce proportion of children and adolescents who have Reduce proportion of children and adolescents who have dental cariesdental caries

Increase numbers of community water systems containing Increase numbers of community water systems containing optimal amounts of fluorideoptimal amounts of fluoride

Healthy People 2010Healthy People 2010 Nutrition ObjectivesNutrition Objectives

88Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Dietary Reference Intakes (DRIs)Dietary Reference Intakes (DRIs)Estimated average requirement (EAR)Estimated average requirement (EAR)

Amount of nutrients estimated to meet needs of half of Amount of nutrients estimated to meet needs of half of healthy individuals in specific age and gender grouphealthy individuals in specific age and gender group

Recommended dietary allowances (RDAs)Recommended dietary allowances (RDAs)Sufficient amount of nutrients to meet requirements of Sufficient amount of nutrients to meet requirements of

nearly all (97%–98%) healthy individualsnearly all (97%–98%) healthy individuals

99Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Dietary Reference Intakes (DRIs)Dietary Reference Intakes (DRIs)Adequate intake (AI)Adequate intake (AI)

Average amount of nutrient that appears to maintain a Average amount of nutrient that appears to maintain a defined nutritional state; more tentative than an RDAdefined nutritional state; more tentative than an RDA

Tolerable upper intake level (UL)Tolerable upper intake level (UL)Maximum daily level of nutrient intake that probably Maximum daily level of nutrient intake that probably

will not cause adverse health or toxic effects for most will not cause adverse health or toxic effects for most individualsindividuals

1010Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Acceptable macronutrient distribution range Acceptable macronutrient distribution range (AMDR) (see Table 1-1)(AMDR) (see Table 1-1)Ensures sufficient intake of essential nutrients while Ensures sufficient intake of essential nutrients while

reducing risk of chronic diseasereducing risk of chronic disease

Estimated energy requirementEstimated energy requirementEnergy intake that is predicted to maintain energy Energy intake that is predicted to maintain energy

balancebalance

Dietary Reference Intakes (DRIs)Dietary Reference Intakes (DRIs)

1111Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

DRIs: Dental Hygiene DRIs: Dental Hygiene ConsiderationsConsiderations

Guidelines apply to Guidelines apply to averageaverage daily intakes daily intakesIndividual’s specific requirement unknownIndividual’s specific requirement unknown

Encourage a variety of healthy food choicesEncourage a variety of healthy food choicesDRIs are guidelines for healthy peopleDRIs are guidelines for healthy peopleUL may be used to warn patients against UL may be used to warn patients against

megadoses of nutrientsmegadoses of nutrients

1212Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Dietary Guidelines for Dietary Guidelines for Americans 2005Americans 2005

Issued by USDA and HHS; Issued by USDA and HHS; updated every 5 yearsupdated every 5 yearsAuthoritative advice for people Authoritative advice for people

2 years and older about how 2 years and older about how good dietary habits can good dietary habits can promote health and reduce risk promote health and reduce risk for major chronic diseasesfor major chronic diseases

U.S. Department of Health and Human Services and U.S. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. Department of Agriculture. Dietary Guidelines for Americans, 2005.

6th ed. Washington, D.C.: U.S. Government Printing Office, 6th ed. Washington, D.C.: U.S. Government Printing Office, January 2005 January 2005

1313Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Dietary Guidelines for Dietary Guidelines for Americans 2005Americans 2005

Key recommendationsKey recommendationsAdequate nutrients within Adequate nutrients within

kilocalorie needskilocalorie needsWeight managementWeight managementPhysical activityPhysical activityFood groups to encourageFood groups to encourageFats and carbohydratesFats and carbohydratesSodium and potassiumSodium and potassiumAlcoholic beveragesAlcoholic beveragesFood safetyFood safety

From U.S. Department of Health and Human Services and U.S. From U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed. Washington, D.C.: U.S. Government Printing 2005. 6th ed. Washington, D.C.: U.S. Government Printing

Office, January 2005. Office, January 2005.

1414Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Dietary Guidelines for Americans 2005: Dietary Guidelines for Americans 2005: Dental Hygiene ConsiderationsDental Hygiene Considerations

Apply only to healthy individuals >2 years of ageApply only to healthy individuals >2 years of ageEncourage nutrient-dense food: whole grains, Encourage nutrient-dense food: whole grains,

fruits, and vegetablesfruits, and vegetablesEncourage moderation in salt, sugar, and Encourage moderation in salt, sugar, and

alcohol intakealcohol intakeEncourage intake of fluoridated waterEncourage intake of fluoridated water

1515Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Food Pyramid SystemFood Pyramid System

1616Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Food Pyramid System: Guiding Food Pyramid System: Guiding PrinciplesPrinciples

Overall Health

Up-to-Date Research

Total Diet

Useful Realistic

Flexible Practical

Evolutionary

1717Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Food Pyramid SystemFood Pyramid SystemMyPyramid was

designed to help people make food choices for meeting nutrient requirements

Foods are grouped according to nutrient content

1818Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Total estimated Discretionary = energy — Essentialcalories requirement calories

Discretionary calories* may be used to:Discretionary calories* may be used to:Increase amount of food selected from a food groupIncrease amount of food selected from a food groupConsume foods that are not in the lowest fat form—Consume foods that are not in the lowest fat form—

such as 2% milk or items that contain added sugarssuch as 2% milk or items that contain added sugarsAdd oil, fat, or sugar to foodsAdd oil, fat, or sugar to foodsConsume alcohol (for those who consume alcohol)Consume alcohol (for those who consume alcohol)

Food Pyramid System Message: Food Pyramid System Message: Discretionary CaloriesDiscretionary Calories

1919Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Food Pyramid System Message: Food Pyramid System Message: Physical ActivityPhysical Activity

In the Dietary Guidelines:In the Dietary Guidelines:Engage in regular physical activity Engage in regular physical activity

and reduce sedentary activities to and reduce sedentary activities to promote health, psychological well-promote health, psychological well-being, andbeing, anda healthy body weight a healthy body weight

In MyPyramid graphic:In MyPyramid graphic:Steps and person on them Steps and person on them

symbolize physical activity symbolize physical activity should be a part of everyday should be a part of everyday healthy livinghealthy living

2020Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Food Pyramid System Message: Food Pyramid System Message: ProportionalityProportionality

In the Dietary Guidelines:In the Dietary Guidelines: Adopt a balanced eating patternAdopt a balanced eating pattern

Sufficient amount of fruits and vegetables Sufficient amount of fruits and vegetables 3 or more ounce equivalents of whole-grain products 3 or more ounce equivalents of whole-grain products

per dayper day3 cup equivalents per day of fat-free or low-fat milk or 3 cup equivalents per day of fat-free or low-fat milk or

milk productsmilk products

In MyPyramid graphic:In MyPyramid graphic: Differing widths of the color bandsDiffering widths of the color bands

suggest about how muchsuggest about how muchfood should be eaten fromfood should be eaten fromeach groupeach group

2121Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Food Pyramid System Message: Food Pyramid System Message: ModerationModeration

In the Dietary Guidelines:In the Dietary Guidelines:Limit intake of saturated and Limit intake of saturated and transtrans fats, and choose fats, and choose

products low in these fats products low in these fats Make choices of meat, poultry, dry beans, and milk Make choices of meat, poultry, dry beans, and milk

products that are lean, low fat, or fat freeproducts that are lean, low fat, or fat freeChoose and prepare foods and beverages with little Choose and prepare foods and beverages with little

added sugars or calorie sweetenersadded sugars or calorie sweetenersIn MyPyramid graphic:In MyPyramid graphic:Food group bands narrow from Food group bands narrow from

bottom to top suggesting to eat bottom to top suggesting to eat nutrient-dense forms of foodsnutrient-dense forms of foods

2222Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Food Pyramid System: Food Pyramid System: Dental Hygiene ConsiderationsDental Hygiene Considerations

Provide information to patients about MyPyramid as it Provide information to patients about MyPyramid as it relates to positive changes in dietary lifestyle changesrelates to positive changes in dietary lifestyle changes

Use the Food Pyramid system to evaluate adequacy Use the Food Pyramid system to evaluate adequacy of a patient’s dietof a patient’s dietEliminating food groups may lead to inadequate intake of Eliminating food groups may lead to inadequate intake of

nutrientsnutrientsIf only nutrient-dense foods are selected,If only nutrient-dense foods are selected,

discretionary kcal can be used on other foodsdiscretionary kcal can be used on other foods

The slogan “Steps to a Healthier You” suggests The slogan “Steps to a Healthier You” suggests improvement should happen in stages over timeimprovement should happen in stages over time

2323Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

1. Start with exercise

2. Focus on food, not grams

3. Go with plants • Eat a plant-based diet 

4. Cut way back on American staples, e.g., red meat

and refined sugars and grains

5. Take a multivitamin and maybe have a drinkCopyright © 2008 Harvard University. For more information about the Healthy Eating Copyright © 2008 Harvard University. For more information about the Healthy Eating

Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard School Pyramid, please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health, of Public Health, www.thenutritionsource.org; and Willett W, Skerrett P: Eat, Drink, ; and Willett W, Skerrett P: Eat, Drink,

and Be Healthy. Free Press/Simon & Schuster Inc, 2005. and Be Healthy. Free Press/Simon & Schuster Inc, 2005.

Other Food Guides: Healthy Eating Other Food Guides: Healthy Eating PyramidPyramid

2424Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Other Food Guides: Eating Well with Other Food Guides: Eating Well with Canada’s Food GuideCanada’s Food Guide

Steps toward better health and Steps toward better health and a healthy body weight include:a healthy body weight include:Eat recommended amount and Eat recommended amount and

types of food each daytypes of food each dayLimit foods and beverages high Limit foods and beverages high

in calories, fat, sugar or salt in calories, fat, sugar or salt (sodium)(sodium)

Be active every dayBe active every day

From Eating Well With Canada’s Food Guide (2007), Health From Eating Well With Canada’s Food Guide (2007), Health Canada. Reproduced with permission of the Minister of Public Canada. Reproduced with permission of the Minister of Public

Works and Government Services Canada, 2009.Works and Government Services Canada, 2009.

2525Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

FDA Authorized Health ClaimsFDA Authorized Health Claims

Qualified health claimsQualified health claims Cancer riskCancer riskCardiovascular disease riskCardiovascular disease riskCognitive functionCognitive functionDiabetesDiabetesHypertensionHypertensionNeural tube birth defectsNeural tube birth defects

2626Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Daily reference Daily reference valuesvaluesBased on 2000-calorie Based on 2000-calorie

dietdiet% DV helps determine % DV helps determine

if a serving of food is if a serving of food is high or low in a nutrienthigh or low in a nutrient

From theFrom the Department of Health and Human Services, Food Department of Health and Human Services, Food and Drug Administration. How to Understand and Use the and Drug Administration. How to Understand and Use the Nutrition Facts Label. June 2000, updated July 2003 and Nutrition Facts Label. June 2000, updated July 2003 and

November 2004. Available: November 2004. Available: www.cfsan.fda.gov/~dms/foodlab.html..

Nutritional LabelNutritional Label

2727Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Which has more calories? Which has more calories? Which one has more saturated fat? Which one has more saturated fat?

Which one has more calcium?Which one has more calcium?

From theFrom the Department of Health and Human Services, Food Department of Health and Human Services, Food and Drug Administration. and Drug Administration. How to Understand and Use the How to Understand and Use the Nutrition Facts Label.Nutrition Facts Label. June 2000, updated July 2003 and June 2000, updated July 2003 and

November 2004. Available: November 2004. Available: www.cfsan.fda.gov/~dms/foodlab.html..