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CHAPTER 16CHAPTER 16
FOOD FACTORS AFFECTING FOOD FACTORS AFFECTING HEALTHHEALTH
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2
Food PatternsFood patterns are generally developed during
childhood and reflect the following influences:CulturalSocioeconomic statusSymbolic (e.g., religious)GeographicalPsychological
All of these influence one’s attitudes, feelings, and beliefs about food
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3
Food Patterns: Cultural Influences
Cultural food patterns establish foundation for child’s lifelong eating patterns regarding:Time and number of meals per dayFoods acceptable for specific mealsPreparation methodsLikes and dislikesFoods suitable for specific members of a groupTable mannersSocial role of foods and eatingAttitudes toward eating and health
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 4
Food Patterns: Status and Symbolic Influences
Because of symbolic meanings of food, eating becomes associated with sentiments and assumptions about oneself and the world
Choice of different foods influenced by:Religious beliefsAvailabilityCostCultural values and traditionsEven endorsement or condemnation by a highly
respected person
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 5
Working with Patients: Respect for Others’ Eating Patterns
Be sensitive to preferences, avoid being judgmental, treat each patient with respect
Intervention must be adapted to address cultural, personal, and ethnic preferences in order to be effective
Use open-ended questions to elicit information
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 6
Working with Patients: Effecting Change
Basic facts that may assist in approaching patients from various ethnic groups to promote sound nutritional practices:People have a remarkable ability to obtain a nutritious
diet out of available foodstuffsFood patterns of other countries are in some instances
nutritionally superior or at least comparable to “ordinary” American traditions
Culturally preferred foods may be costly or unavailable in some communities
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 7
Working with Patients: Effecting Change
Basic facts that may assist in approaching patients from various ethnic groups to promote sound nutritional practices (cont’d):Each food/food-related behavior and tradition is
categorized as beneficial, neutral, or potentially harmful Efforts at change should be focused on potentially harmful food
behaviors/choices
Food patterns are generally deeply ingrained; suggest minimal alterations in the patient’s normal patterns
Cultural patterns tend to be used more consistently by older family members (first-generation immigrants)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 8
Working with Patients: Religious Food Restrictions
Religious beliefs affect eating patterns, attaching symbolic meanings to food and drink, such as:Bread and wine served during the Christian
communion serviceHindu reverence for the cowThe month-long fast of Ramadan of the Muslim faithMany Seventh-Day Adventists are vegetarians or
vegans
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 9
Food BudgetsEvidence of poor or fair health status and
malnutrition increases as income level decreasesLow-income households score below higher income
households on healthy eating indices
Average American family spends approx 15% of income on food; those at poverty level spend as much as 33%Foods supplying the most nutrients relative to cost
include beef, fresh potatoes, brown rice, wheat germ, milk, eggs, and peanut butter
Lack of transportation may limit options for shopping
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 10
Referrals for Nutritional ResourcesArea Information Center (211) has comprehensive
databases of resources: federal, state, and local agencies, community-based and private nonprofit organizations
Supplemental Nutrition Assistance Program (formerly Food Stamp Program) is cornerstone of US nutrition safety net
Special Supplemental Food Program for Women, Infants and Children (WIC) designed to prevent nutritional problems in high-risk, low-income groups
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11
Referrals for Nutritional Resources
USDA breakfast and lunch programs provide nutritious free and reduced-price meals for children at school
Nutrition Program for the Elderly (Title III) provides group and home-delivered meals (Meals on Wheels)
Expanded Food and Nutrition Education Program (EFNEP) assists with meal planning, budgeting, cooking, and other food- and nutrition-related problems
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12
Referrals for Nutritional ResourcesHead Start is a preschool educational program
for low-income families; meals are furnished for the children, and nutrition education is available for parents
Locally funded food agencies provide assistance through food banks and food pantries83% of the food banks report they are unable to
adequately meet the needs of their community
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 13
Maintaining Optimal Nutrition During Food Preparation
Methods of preparationDiscourage addition of large amount of fat for cookingDo not discard water that vegetables are cooked in
Food sanitation and safetyFive major control factors for food safety
Personal hygiene Adequate cooking Avoiding cross-contamination Keeping food at safe temperatures Avoiding foods from unsafe sources
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 14
Maintaining Optimal Nutrition During Food Preparation
Effects of processing on nutrientsNutrients considered stable if at least 85% of original
level is retained during processing and storageFood processing attempts to maintain optimal qualities
of color, flavor, texture, and nutritive value
Convenience foodsPopular because save time in meal preparation,
planning, purchasing, and cleanupRequire more preservatives; contain more fat, sodium
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 15
Maintaining Optimal Nutrition During Food Preparation
Irradiated foodsProcess of treating food with controlled amounts of
ionized radiation for prescribed period to kill spoilage- and disease-causing bacteria and molds
Can lengthen the period of ripeness of fruits and vegetables, prolong the freshness of many foods along with preventing certain foodborne illnesses
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 16
Maintaining Optimal Nutrition During Food Preparation
Organic foodsGrown without synthetic pesticides, growth
hormones, antibiotics, or genetic engineeringUSDA does not support claims organic food is
safer or more nutritious than conventionally produced foods But several studies demonstrate they contain more
polyphenols or antioxidants that have potential human health benefits
Cost is higher than conventional products
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 17
Maintaining Optimal Nutrition During Food Preparation
Fast foodsAverage meal between 900 and 1800 kcal (33%–66%
of RDA for young men or 45% 90% for young women)Sodium content high: ranges from 1000 to 2515 mgFat content of some meals can be as high as 51% of
kcal consumedMega-size portions may contain a day’s
worth of kcal in one meal Wise choices possible with new menu
items and reduced portion sizes
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 18
Maintaining Optimal Nutrition During Food Preparation
Food additivesAdditives deemed to be
harmless are labeled “generally recognized as safe” (GRAS)
99% of additives derived from natural sources or synthetically produced to be identical to the natural chemical substance
Food additives have several benefits: Improve nutritional value
(enrichment) Maintain wholesomeness and
palatability (preservatives) Maintain product consistency Provide leavening or control
pH Enhance flavor, appearance
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 19
Food Fads and Misinformation
Purveyors of misinformation capitalize on fears and hopesFood fad is a catch-all term covering all aspects of
nutritional nonsense, characterized by exaggerated beliefs about the value of nutrition in health and disease Fad diets capitalize on those looking for a magic weight loss
formula
Food quackery is promotion of nutrition-related products or services having questionable
safety and/or effectiveness for the claims
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 20
Food Fads and Misinformation
Identifying sources of nutrition misinformationEvaluate findings in light of well-established
nutrition principlesCheck the credentials of person making a
questionable claimA single study is never perfect, providing
conclusive information, but provokes more questions for further studies Single study is not very meaningful by itself but
serves as another piece of the puzzle if it can be replicated
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 21
Food Fads and Misinformation
Role of the dental hygienistAssess patients’ use of food fads, economic level,
educational level, and nutrient adequacy of any fad diet undertaken
Provide positive advice based on a broad knowledge base and understanding of nutritional concepts and current research findings
Do not offer remedies unless they have been demonstrated to be safe and effective
Referral to a registered dietitian may be needed
HEALTH APPLICATIONFood Insecurity
Discuss the impacts of food insecurity in the USConsider the various populations impacted by
food insecurities
Discuss factors accounting for increased food insecurity in the US
Discuss why food insecurity is a major public health concern
Discuss food insecurity in relation to the goals of Healthy People 2020
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 22