|Year : 2014 | Volume
| Issue : 2 | Page : 55-56
A dash for health: A person centered nutrition advice
Sanjal Kalra1, Manash P Baruah2, Bharti Kalra3
1 Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
2 Department of Endocrinology, Excelcare Hospitals, Guwahati, Assam, India
3 Department of Obstetrics and Gynecology, Bharti Hospital and BRIDE, Karnal, Haryana, India
|Date of Web Publication||6-May-2014|
Manash P Baruah
Excel Center (an initiative of Excelcare Hospitals), Maya Ville, Barthakur Mill Road, Ulubari, Guwahati, Assam - 781 007
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalra S, Baruah MP, Kalra B. A dash for health: A person centered nutrition advice. J Med Nutr Nutraceut 2014;3:55-6
Healthy nutrition has always been synonymous with good health. The modern concept of nutrition has expanded in recent years, however, to include newer aspects. This is aptly described in a famous quote by Dick Gregory, which reads as follows: "I went to Ethiopia, and it dawned on me that you can tell a starving, malnourished person because they've got a bloated belly and a bald head. And I realized that if you come through any American airport and see businessmen running through with bloated bellies and bald heads, that's malnutrition, too."  The term 'malnutrition', which earlier evoked pictures of calorie and protein deprivation, now applicable to over-consumption of food also.
Continuous evolution of nutrition science has meant that physical activity is now studied as a part of lifestyle management, alongside dietary issues. Meanwhile, within the well defined framework of dietetics, emphasis has moved away from algorithmic recommendations advising the consumption of specified calories per unit body weight, while dividing them into predecided nutrient groups. Current guidelines propose shifting to healthy diet patterns, and describe the composition of those patterns. This is precisely what has been done in the American Health Association/American college of Cardiology (AHA/ACC) guideline in lifestyle management to reduce cardiovascular risk, released in 2013.  The AHA/ACC guideline suggests two main methods of planning a cardio-friendly diet. The Mediterranean (MED) and Dietary Approaches to stop Hypertension (DASH) diet pattern are graded as having low and high evidence to back them. Other dietary patterns described are variants of the DASH diet. The AHA/ACC guideline lists the literature behind these statements to suggest evidence-based recommendations for lifestyle management to reduce cardio-vascular risk. It also covers the field of physical activity, suggesting regular aerobic exercise as a means of improving blood pressure and lipid health. These guidelines are meant for primary health care professionals, and have global relevance. To improve their utility, this editorial tries to paraphrase these recommendations in an India-centric manner. An understanding of these two basic patterns can help inform a rational nutrition prescription in all ethnic, and age groups, irrespective of comorbidity profile.
| Mediterranean diet pattern|| |
The term Mediterranean diet  is used for diets that resemble those consumed in Southern Europe, West Asia, and North Africa, surrounding the Mediterranean sea. The Mediterranean diet describes a pattern of food intake which focuses on food groups rather than calorie counting. Mediterranean diets are high in fruits and vegetables, whole grains, and fatty fish; avoid red meat, use low fat free dairy products instead of high - fat dairy foods; and utilize oils, such as rapeseed or flaxseed instead of butter, for cooking. Mediterranean diets are usually composed of 32-35% calories from fat, including 9-10% from saturated fat. They are high in fiber (27-37 g/day) and polyunsaturated fatty acids, especially omega-3 fatty acids. Adherence to a Mediterranean diet pattern helps in reducing blood pressure by 6-7/2-3 mmHg in middle aged and elderly adults, and 2-3/1-2 mmHg in healthy young adults. However, no definite benefits have been noted on lipid levels.
| Dash diet pattern|| |
The DASH diet  is backed by strong evidence as it has been used in multiple large scale studies. Rich in vegetables, fruits, low fat dairy products, whole grains poultry, fish and nuts, and low in sweets, sugar-sweetened beverages, and red meals. This makes it low in saturated fat, total fat, and cholesterol, and rich in potassium, magnesium, calcium protein, and fiber. Use of the DASH diet helps reduce blood pressure by 5-6/3 mmHg in adults with hypertension. In adults with dyslipidemia, it reduces low-density lipoprotein cholesterol (LDL-C) by 4 mg%, and high-density lipoprotein cholesterol (HDL-C) by 4 mg%, without affecting serum triglycerides. These beneficial effects are noted in all subgroups studied, irrespective of ethnicity, gender, age, and baseline blood pressure.
Variations of the DASH diet have also been studied. Replacing 10% of total energy intake with protein or unsaturated fat (8% monounsaturated fat, 2% poly unsaturated fat) reduced systolic blood pressure by 1-3 mmHg in hypertensive adults. Replacing carbohydrates with protein, to the tune of 10% of total calories, reduces. LDL-C by 3 mg/dL, HDL-C by 1 mg/dL and triglycerides by 16 mg/dL as compared with the conventional DASH diet. Replacing the same with unsaturated fat achieves the same reduction for LDL-C, while increasing HDL-C by 1 mg/dL and lowering of triglycerides by 10% as compared with the conventional DASH pattern.
Replacing saturated fatty acids with carbohydrate, monounsaturated fatty acids, or polyunsaturated fatty acids helps improve lipid profile as well. Better improvements are noted if carbohydrate is replaced by mono-unsaturated fatty acids, and if transmono-unsaturated fatty acids are replaced by cis-fatty acids or carbohydrate.
Health care providers should focus more on diet patterns instead of encouraging calorie counting. One should promote the use of vegetables, fruits, low-fat milk, yoghurt, and butter milk. Whole grains should be encouraged in place of processed grains. Nonvegetarians should replace red meats (mutton, beef) for poultry or fish. Refined vegetable cooking oils should be used in preference to ghee or 'dalda' (hydrogenated fat). Limiting the consumption of sweets and soft drinks, while following the above-mentioned suggestions will ensure a healthy dietary pattern eventually minimizing cardiovascular risk.
| References|| |
Available from: http://www.brainyquote.com/quotes/quotes/d/dickgregor472468.html#bxfEpKf7qDAoS11s. 99. [Last accessed on 2014 Feb 07].
Eckel RH, Jakicic JM, Ard JD, Miller NH, Hubbard VS, Nonas CA, et al
. AHA/ACC Guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2013. pii: S0735-1097 (13) 06029-4.
Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al
. Effects of a Mediterranean-style diet on cardiovascular risk factors: A randomized trial. Ann intern Med 2006;145:1-11.
Sacks FM, Appel LJ, Moore TJ, Oberzanek E, Vollmer WM, Svetkey LP, et al
. A dietary approach to prevent hypertension: A review of the Dietary Approaches to Stop Hypertension (DASH) Study. Clin Cardiol 1999;22(Suppl. III);III-6-III-10.