LIFESTYLE MODIFICATIONS REVIEW

OBJECTIVE: Discuss the importance of proper nutrition for the prevention of chronic diseases

OBJECTIVE: Describe the six classes of nutrients for overall health

OBJECTIVE: Summarize the healthy eating recommendations in the American Heart Association Dietary Guidance

OBJECTIVE: Counsel a patient on the appropriate use of Alli (orlistat)

OBJECTIVE: Describe the Physical Activity Guidelines for Americans recommendations

Health Behavior Change: Fundamental Components

Self-efficacy

Patient is the center of behavior change process

Effective communication, intervention, and follow-up

Evaluate and discuss concepts with the patient when designing a disease prevention program

Nutrition

DIRECTLY related to chronic diseases

Complications of heart disease, cancer, stroke, and diabetes are attributed to a poor diet

74% of adults are either overweight or obese; 50% of adults have 1 or more diet related chronic disease

What factors decrease the risk of development of chronic disease?

Healthful diet

Exercise

Moderate alcohol intake

Abstaining from Smoking

What is metabolic rate dependent on?

Basal metabolic rate (minimum number of calories your body needs to perform life functions)

Thermic effect of food (Energy body uses to digest, absorb, and metabolize nutrients)

Physical activity

Macronutrients

Carbohydrates
Fats

Proteins

Micronutrients

Vitamins

Minerals

Water

What is the difference between micronutrients and macronutrients?

Macronutrients are used for energy storage

Micronutrients are smaller in amount and help the body be healthy and digest

Carbohydrates

Major energy source

45-65% of daily calories

Simple Carbohydrates

Sugars (mono/di/trisaccharides): Supply calories with little to no nutrients to our diet

Complex Carbohydrates

Starches/polysaccharides: Storage form of carbohydrates; supplies energy in the form of glucose

Dietary Fiber Carbohydrates

Non-starch carbohydrates from plant foods not digested by enzymes in small intestines

What do plant rich in fiber decrease the risk of?

Coronary heart disease and potentially diabetes risk as well

Fats

Carrier absorption of fat-soluble vitamins

20-35% of daily calories

Unsaturated Fatty Acids

• Should represent 10-20% respectively, of the total daily caloric intake

• Liquid at room temperature

• Reduce the amount of newly formed cholesterol and helps lower blood cholesterol levels

Saturated Fatty Acids

Associated with increases in total and LDL cholesterol

Solid at room temperatures

Cis/trans fats

Usually found in meat and dairy products and baked goods

Associated with higher risk for coronary heart disease

Cholesterol

Fat-like substance found in animals

Not an essential nutrient

High consumption → increased serum cholesterol and LDL → increased risk for coronary heart disease (CHD)

Protein

Source of energy

Provides essential amino acids

Regulate metabolism

Provides structural basis for tissues

Vitamins

Maintenance of physiologic and energy processes

Not a source of energy → no caloric value

Antioxidant Vitamins

Vitamins E, C, and beta carotene

Fat Soluble Vitamins

A, D, E, and K

Water Soluble Vitamins

Eight B-Complex vitamins and Vitamin C

Minerals

Component for building tissues and regulation of metabolism

Not an energy source or calories

Water

Most essential nutrient

• Function of other nutrients depends on its presence

• Food digestion

• Normal metabolism

• Regulate body temperature

• Carrier of all electrolytes

Balanced intake to prevent dehydration and electrolyte imbalance

Adjust energy intake and expenditure to achieve and maintain a healthy body weight

Emphasize

• Fruits, vegetables, whole grain foods, healthy protein sources, and liquid plant oils.

Minimize

• Beverages and foods with added sugars, ultra-processed foods, processed meats, foods high in salt, alcoholic beverages, tropic oils.

Eat plenty of fruits and vegetables, choose a wide variety

Dietary patterns rich in fruits and vegetables are associated with a reduced risk of CVD

Deeply colored fruits and vegetables tend to be more nutrient dense

Whole fruits and vegetables provide more dietary fiber and satiety than their respective juices.

Choose foods made mostly with whole grains rather than refined grains

Daily intake of foods made with whole grains is associated with lower cardiovascular disease (CVD) risk, coronary heart disease (CHD), stroke, metabolic syndrome, and cardiometabolic risk factors

Choose healthy sources of proteins

Plants

Regular intake of fish and seafood

Low-fat or fat-free dairy products instead of full-fat dairy products

If meat or poultry desired, choose lean cuts and avoid processed forms

Use liquid plant oils rather than tropical oils, animal fats, and partially hydrogenated fats

• Cardiovascular benefits of dietary unsaturated fats when they replace saturated and trans fats.

• Saturated and trans fats should be replaced with nontropical liquid plant oils.

Choose minimally processed foods instead of ultra-processed

• Ultra-processed include foods with salt, sweeteners, or fat to include artificial colors, flavors, and preservatives that promote shelf stability, preserve texture and increase platability.

• Ultra-processed associated with adverse health outcomes, including overweight and obesity, cardiometabolic disorders, and all-cause mortality

• Greater risk of T2D

Minimize intake of beverages and foods with added sugars

• Added sugars refer to sugars being added during preparations or processing.

• Added sugars → increase risk of T2D, CHD, and excess body weight.

• Recommended to minimize the intake of added sugars across the lifespan.

Choose and prepare foods with little or no salt

• Direct positive relationship between salt (sodium chloride) intake and blood pressure

• Leading sources of dietary sodium are processed foods, foods prepared outside the home, packaged foods, and restaurant foods

• Replace regular salt with potassium-enriched

If you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake

No more than one drink per day and should not drink alcohol in binges.

Adhere to the guidance regardless where food is prepared or consumed

Food-based dietary guidance applies to all food and beverages

Alli

• Active ingredient: Orlistat

• Indication: Weight loss in overweight adults when used along with a reduced-calorie and low-fat diet

• MOA: Reversible inhibitor of intestinal lipases

• Efficacy: At therapeutic doses, orlistat inhibits dietary fat absorption by approximately 30%

Orlistat dosing

• OTC: 60 mg tid during or within 1 hour of each fat-containing meal

• Reference: 120 mg tid during or within 1 hour of each fat-containing meal

Evidence Based Studies of Orlistat

• Orlistat + behavioral intervention lose 5-10 kg compared to 3-6 kg in the control group.

• Weight loss was maintained with up to 24-36 months of orlistat treatment

Contraindications of Alli

• Chronic malabsorption syndrome

• Hypersensitivity to orlistat or any other component of the product

• Pregnancy, nursing mothers, and pediatric patients

Precautions of Alli

• Reduced absorption of cyclosporine

• Reduced absorption of fat-soluble vitamins (ADEK) and beta-carotene absorption

• Potential misuse in inappropriate patient populations, such as those with anorexia nervosa or bulimia

Side Effects of Alli

Abdominal discomfort, abdominal pain, defaction urgency, discharge from anus, oily and loose stools, flatulence, anal leakage

Counseling Points of Alli

• Administer during or up to 1 hour after meals containing fat

• Doses may be skipped if a meal is missed or contains no fat

• Do not take more than tid

• Separate orlistat dose at least 2 hours from daily multivitamin supplement (ADEK)

• Gastrointestinal adverse effects generally decrease after the first month of therapy

How many adults and adolescents do NOT meet the guidelines for both aerobic and muscle-strengthening activites?

More than 80%

Benefits of Physical Activity

• Ages 3-5: Improved bone health and weight status

• Ages 6-13: Improved cognitive function

• Brain health benefits

• Reduced risk of fall-related injuries

• Reduced risk of all-cause and disease specific mortality

• Reduces risk of premature death, CHD, stroke, HTN, 2nd MI, high cholesterol, T2D, breast and colon cancer, metabolic syndrome, depression and falls

• Achieving and maintaining a healthy weight

Physical Activity

Any bodily movement produced by skeletal muscles that results in the expenditure of energy

Physical Inactivity

Lack of any regular pattern of physical activity beyond that required for daily functioning

Exercise

Planned or structured physical activity

Preschool-Aged Children PAG Guidelines for Americans

Physically active throughout the day

Children PAG Guidelines for Americans

• 60 minutes to an hour or more of moderate-to-vigorous physical activity daily.

  • Aerobic: 60 min or more with vigorous-intensity physical activity at least 3 days a week.

  • Muscle-strengthening at least 3xweek

  • Bone-strengthening at least 3xweek

Adults PAG Guidelines for Americans

AVOID INACTIVITY

150-300 min a week of moderate OR 75-150 minutes of vigorous intensity activity

Muscle strengthening 2 x week

Older Adults PAG Guidelines for Americans

• Multicomponent physical activity including balance training and aerobic and muscle-strengthening activities

• Level of effort relates to their level of fitness

• As physically active as their abilities and condition allow

Components of Physical Activity

Warm-up → aerobic conditioning → resistance training → stretching → cool down

Warm Up and Cool Down

Transition from rest → exercise
Gradual return of the heart rate, bp, blood circulation, and respiration to the pre-exercise state

Time spent doing warm-up and cool-down may count toward aerobic key guidelines

Muscle Strengthening Activity

Allows the body to improve muscular strength and endurance

Bone strength and muscular fitness

Balance and coordination and mobility

Decreases fall risk, especially for the elderly

Flexibility Activities

Increases musculoskeletal function, balance, and agility

Functional capabilities

Reduced injury potential

Enhances the ability of a joint to move through the full range of motion

Increases flexibility

4 repetitions per muscle group 2-3 days/week

Physical Activity Prescription

Assessment

Short term goals

Long term goals

Type of activity

Intensity

Duration
Frequency

Assessment Periods