Nutrition and Disease

College of Public Health

Zhengzhou University
By Yacong Bo
[email protected]
Nutrition and Disease

Which factors can influence our health?

Genetic, environmental, behavior, medical care, and social factors

Which factors are changeable?

Environmental, behavior, medical care, and social factors

Which factors are behavior factors?

Eating habit, physical activity, sleep pattern
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Nutrition and Disease

 Obesity
 Diabetes
 Hypertension
 Cardiovascular disease
 Gout
 Cancer
 Infectious disease

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Obesity

• One of the major nutrition-related diseases

• Defined as excessive fat accumulation that may
have adverse effect on health
• Is usually being classified by body mass index
(BMI, weight-for-height, kg/m2), while the body
fat composition also should be taken into
consideration.

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Obesity

The classification of adult overweight and obesity according to BMI

WHO Asia China Degree of obesity
18.5-24.9 18. 5-22. 9 18. 5-23. 9 Normal
25-29. 9 23-24. 9 24-27. 9 Overweight
≥30 ≥25 ≥28 Obesity
25-29. 9 Mild obesity
30- 34. 9 Moderate obesity
≥35 Severe obesity

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Obesity

 Types of obesity
• Simple obesity (majority)
Simple obesity has no obvious nerve or endocrine
system morphology and function changes, but is
accompanied with fat, and glucose metabolism
disorders.
• Secondary obesity (rarely seen clinically)
A symptom derived from a certain metabolic or
endocrinal disease, accounting for only about 5% of
obese patients

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Obesity

 Key facts
• Worldwide obesity has nearly tripled since 1975.
• In 2016, more than 1.9 billion adults, 18 years and older, were
overweight. Of these over 650 million were obese.
• 39% of adults aged 18 years and over were overweight in
2016, and 13% were obese.
• Most of the world's population live in countries where
overweight and obesity kills more people than underweight.
• 39 million children under the age of 5 were overweight or
obese in 2020.
• Over 340 million children and adolescents aged 5-19 were
overweight or obese in 2016.
• Obesity is preventable.

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Obesity

 Cause of obesity
• Behavior factors
Diet
Physical activity
Sleep
Mental
• Genetic factors
Genes related to body fat mass and distribution (e.g. fat
mass and obesity-associated (FTO) gene)

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Obesity

 Dietary factors
• Total calorie intake
• Dietary Pattern
• Food components
• Eating habit

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Obesity

 Physical activities
• Less labor work
• Convenient transportation
• Heavy load homework
• Longer sitting time (for study, work, or
entertainment)

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Obesity

 The health consequence of childhood obesity

• Ongoing obesity in later life
• Concomitant risk of some serious diseases, such as
diabetes, cardiovascular disease and cancer
• Growth and development (more series!!!)
• Children’s mental and psychological behavior

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Obesity

 The health consequence of obesity in adults

Increased risk of CNDs, CHD, DM, cancer,
hypertension, mental problems, joint problems……

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Obesity

 Diet and obesity

• Energy intake>energy consumption
• Fiber
 High expansibility and water-holding capacity make
nutrients absorbed slowly
 Absorb bile acids and cholesterol to lower plasma
cholesterol
 Foods rich in dietary fiber contain only a small
amount of fat

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Obesity

 Prevention and control

• Obesity is not easy to treat, but preventable, which
is even more important

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Obesity-PREVENTION AND CONTROL

 Weight loss (the most basic and effective way)

• Regular eating
• Less carbohydrates
• Adequate protein
• Strict restrictions of fats
• Adequate minerals and vitamins
• Appropriate dietary pattern
• Adequate excise

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Obesity-PREVENTION AND CONTROL

 Regular eating
• Snacks (e.g., desserts, candies, chocolates and
beverages, which have a very high sugar and other
nutrients are relatively lower with high energy
density).
• Fried foods and ice cream are high-sugar, high-fat
foods.
• Alcohol is pure-energy food, and all kinds of
alcohol have different ratios of ethanol

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Obesity-PREVENTION AND CONTROL

 Less carbohydrates
• Daily intake of carbohydrates should account for
55% -65% of the total energy
• High-dietary-fiber foods, without some fast
absorbing or other monosaccharides and
disaccharides

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Obesity-PREVENTION AND CONTROL

 Adequate protein
• Daily intake of protein should account for 15% -
20% of the total energy
• Excessive protein intake can cause damage to liver
and kidney function, so daily intake of protein
should not be too high

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Obesity-PREVENTION AND CONTROL

 Strict restrictions of fats

• daily intake of fat should be 20% -30% of the total
energy
• Do not use or use less saturated animal oil

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Obesity-PREVENTION AND CONTROL

 Adequate minerals and vitamins

• The intake of minerals and vitamins can lubricate
the body machines and make them work more
harmoniously

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Obesity-PREVENTION AND CONTROL

 Reasonable dietary pattern

• Staple foods, meats, poultries, dairy products,
vegetables and fruits should be included in three
meals of obese patients, as well as low-fat, high-
protein foods

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Obesity-PREVENTION AND CONTROL

 Adequate excise
• Weekly playing football, walking or swimming and
other appropriate regular exercise can effectively
prevent the formation of obesity
• All healthy adults (ages 18-64) should get at least 2
hours and 30 minutes (150 minutes) of moderate-
intensity aerobic physical activity (e. g. ,brisk
walking) every week or 1 hour and 15 minutes (75
minutes) of vigorous intensity aerobic physical
activity (e.g. ,jogging, running) every week

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Diabetes

 Definition
• Diabetes is a chronic, metabolic disease
characterized by elevated levels of blood glucose
(or blood sugar), which leads over time to serious
damage to the heart, blood vessels, eyes, kidneys
and nerves

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Diabetes

Diagnose

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Diabetes

 Prevalence
• Global prevalence is 459.8 million
• Incidence 22.2 million
• Diabetes directly caused 1. 5 million deaths in 2019

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Diabetes

 Classification
• Type 1 diabetes
• Type 2 diabetes

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Diabetes

 Type 1 diabetes
• Characterized by the lack of insulin secretion
• Usually diagnosed before the age of 30 years in
people who are of normal or below normal weight

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Diabetes

 Type 2 diabetes
• 90-95% of diabetes cases
• Characterized by hyperinsulinemia and insulin
resistance
• Hyperglycemia provides constant stimulation for
insulin secretion, further aggravating
hyperinsulinemia

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Diabetes

 Management
• Health education
• Physical activity
• Nutritional therapy
• Pharmacotherapy

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Diabetes

 Health education
• Make the patients aware of DM and get to know
glucose self-test methods, to be confident for the
treatment and be actively involved in the treatment

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Diabetes

 Physical activity
• Weight control
• Improving dyslipidemia,
• Blood pressure control,
• Increasing insulin sensitivity
• Lowering risk of CHD

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Diabetes

 Nutrition Therapy
• Maintaining desirable body weight
• Keeping a diet rich in dietary fiber, soy protein,
antioxidant, and water-soluble vitamins, but low in
fat and cholesterol
• At the stage of pre-DM, the appropriate dietary
plan could effectively prevent it from DM
development

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Diabetes The fundamental measure of diabetes
treatment should be carried out during the
entire process of diabetes treatment
 Dietary Therapy
• Control the appropriate amount of energy
intake: The total energy requirement should be
calculated based on age, physical activity level and
body weight.
• Carbohydrate: Carbohydrates should provide 55%
to 65% of total energy. Low glycaemic index (GI)
is preferred.
Glycaemic index (GI) is a measure of
the effects of carbohydrate
consumption on blood sugar levels.
the low GI carbohydrates refer that
carbohydrates break down more
slowly,releasing glucose more
gradually into the bloodstream 33
Diabetes
GI for common foods in China

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Diabetes

 Dietary Therapy
• Protein: Protein intake for diabetic people should be
more than non-diabetes people. It is suggested to have
protein accounting for 15% of total energy intake.
• Fat: Fat intake should not exceed 30% of total energy.
Saturated fatty acid (SFA) should not be more than 10%
of total energy.
• Fiber: Dietary fiber has therapeutic value in diabetes
and may even reduce the prevalence of diabetes. It is
recommended to consume 25-35 g/ d or 15-25 g/1,000
kcal of dietary fiber for diabetic patients.
• Enough vitamins and minerals are recommend
• Alcohol: Persons with poorly controlled diabetes should
avoid alcohol consumption, which could induce fasting
hypoglycemia by inhibition of gluconeogenesis. 35
Diabetes

 Pharmacotherapy
• If nutritional therapy and physical activity could
not control plasma glucose well, providing
hypoglycemic medicine should be taken into
account. Oral pills of hypoglycemia are priority for
T2DM patients, while insulin is suitable for T1DM
and poorly controlled T2DM.

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Hypertension

 Definition
• Hypertension, or high blood pressure is a chronic
disease characterized by a continuous increase in
arterial blood pressure accompanied by progressive
damage to the structure and function of the heart,
brain, kidney and blood vessel walls.

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Hypertension

Diagnosis

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Hypertension

 Prevalence
• An estimated 1.28 billion adults aged 30-79 years
worldwide have hypertension, most (two-thirds) living
in low- and middle-income countries
• Less than half of adults (42%) with hypertension are
diagnosed and treated.
• One of the global targets for noncommunicable diseases
is to reduce the prevalence of hypertension by 33%
between 2010 and 2030

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Hypertension

 Classification
• Primary hypertension: an independent disease
characterized by elevated blood pressure, unknown
cause, accounting for more than 95% of hypertension,
may be the result of a combination of genetics and poor
lifestyle choices

• Secondary hypertension: may arise as a complication of

another disease, especially with the disease of endocrine
system. The patients with secondary hypertension can be
recovered after the treatment of the underlying condition

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Hypertension

 Cause
• Genetics
• Diet: e.g., high alcohol intake, high salt intake, low
dairy, fruit and vegetable intake. Hypertension is the
most closely related to salt intake
• Occupational and environmental factors: Workers
with high concentration, long-term stress, long-term
exposure to environmental noise and adverse visual
stimuli are prone to hypertension
• Other factors: Smoking, drinking, obesity

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Hypertension

 Nutrition prevention
• Body weight control: It can reduce the incidence of
hypertension by controlling total energy intake and
increasing physical activity to reduce body weight
• Diet: Dietary approaches to stop hypertension (DASH) is
a hypertension-based dietary model developed by the
National Institutes of Health and National Heart, Lung and
Blood Institute of the USA. DASH is characterized by rich
in fruits and vegetables; including whole grains, poultry,
fish and nuts, which are rich in potassium, calcium,
magnesium as well as low protein, total fat, saturated fatty
acids and cholesterol.
• Limit sodium intake
• Moderate intake of high-potassium foods
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• Life styles: Quit smoking and control alcohol intake
Cardiovascular diseases

 Definition
• Cardiovascular diseases (CVDs) are a group of disorders
of the heart and blood vessels, which mainly include
coronary heart disease, cerebrovascular disease,
rheumatic heart disease and other conditions.

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Cardiovascular diseases

 Key facts
• Cardiovascular diseases (CVDs) are the leading cause of death
globally.
• An estimated 17.9 million people died from CVDs in 2019,
representing 32% of all global deaths. Of these deaths, 85% were
due to heart attack and stroke.
• Over three quarters of CVD deaths take place in low- and middle-
income countries.
• Out of the 17 million premature deaths (under the age of 70) due
to noncommunicable diseases in 2019, 38% were caused by
CVDs.
• Most cardiovascular diseases can be prevented by addressing
behavioural risk factors such as tobacco use, unhealthy diet and
obesity, physical inactivity and harmful use of alcohol.
• It is important to detect cardiovascular disease as early as possible
so that management with counselling and medicines can begin. 44
Cardiovascular diseases

 Risk factors
• High blood pressure
• High low-density lipoprotein (LDL) cholesterol
• Diabetes
• Smoking and secondhand smoke exposure
• Obesity
• Unhealthy diet
• Physical inactivity.

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Cardiovascular diseases

 Nutrition prevention
• To limit the total calorie intake, and to maintain the ideal
body weight
• To limit fat and cholesterol intake
• To improve plant protein intake, and to eat less sweet
food
• To ensure adequate dietary fiber intake
• To keep adequate supply of vitamins and minerals
• To have light diet, and less salt
• To have more protective foods at appropriate quantities.

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Gout

 Definition
• Gout is a chronic and progressive disease caused by
purine metabolism disorder that results from an
overload of uric acid in the body (either over-
produced or less discharged of uric acid)
• The clinical symptoms of gout include
hyperuricemia, recurrent attack of acute
inflammatory arthritis, and kidney stones, or urate
nephropathy

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Gout

 Diagnosis
• Hyperuricemia, plasma uric acid >420 umol/ L
(male); >350 umol/ L(female).
• Uric acid crystal is found in synovial fluid under
microscope.
• Identified chalkstone as uric acid crystal.
• Therapeutic effect is positive after colchicine
treatment

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Gout

 Prevalence (2019)
• Global prevalence is 53.9 million
• Incidence 9.2 million

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Gout

Source: Global burden of disease study, https://vizhub.healthdata.org/gbd-results/? 50

params=gbd-api-2019-public/fd46f50ef61907ad19ae2646d60c9aae
Gout

 Risk factors
• Having high urate levels; however, not everyone who has
high levels develops gout.
• Having a family history of gout.
• Increasing age.
• Drinking alcohol.
• Eating foods that are rich in purines (usually from animal
sources), a substance that breaks down into urate.
• Drinking beverages that have high-fructose corn syrup,
such as soda.

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Gout

 Risk factors
Some health conditions may increase the risk of developing gout
• Overweight or obesity
• Metabolic syndrome
• Chronic kidney disease
• Conditions that cause the cells to turn over rapidly, such as
psoriasis, hemolytic anemia, or some cancers.
• Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome, two
rare conditions in which the body either does not have the
enzyme that regulates urate levels or does not have enough of
that enzyme.

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Gout

 Treatment
Depending on the symptoms and the cause of gout,
treatment plans may differ from person to person.
However, the goals for treating gout are the same for
each person and include:
• Reduce the pain from gout flares.
• Prevent future flares.
• Prevent and resolve tophi to stop damage to the joints.
• Care for other conditions or complications that happen
with gout, such as heart and kidney diseases.

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Gout

 Prevention
There are many things we can do to help manage gout. We
can make some lifestyle changes to help having fewer gout
flares and manage the symptoms, such as
• Losing weight. If we are overweight or obese, losing
weight through a reduced calorie diet and increased
exercise helps reduce urate levels, which can help stop or
lower the number of flares we have.
• Making diet changes to help reduce blood urate levels and
gout flares, such as:
 Drinking fewer alcoholic beverages.
 Avoiding drinks that have high-fructose corn syrup, such as
soda.
 Avoiding red meats and organ meats (liver, kidney, tongue,
and sweetbreads) that are higher in purines and may increase
the risk for other health conditions.
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 Avoiding seafood.
Gout

 Prevention
Following the Dietary Approaches to Stop Hypertension
(DASH) eating plan. This diet is particularly helpful for the
many gout patients who also have high blood pressure. The
DASH eating plan can help improve high blood pressure and
may help lower blood urate levels. By lowering urate levels,
this plan may help prevent gout flares. The DASH eating plan
includes:
• Eating plenty of vegetables, fruits, and whole grains.
• Eating low-fat or fat-free dairy products, poultry, and oils.
• Limiting foods high in saturated fats.
• Limiting sugar-sweetened foods and drinks.
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Cancer

• Cancer is a large group of diseases that can start in almost any

organ or tissue of the body when abnormal cells grow
uncontrollably, go beyond their usual boundaries to invade
adjoining parts of the body and/or spread to other organs. The
latter process is called metastasizing and is a major cause of
death from cancer.

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Cancer

 Prevalence
• Global prevalence is 485.4 million
• Incidence 305.1 million
• Cancer directly caused 10.1million deaths in 2019

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Cancer

 Male common cancer: Lung, prostate,

colorectal, stomach and liver cancer

 Female common cancer: Breast, colorectal,

lung, cervical and thyroid cancer

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Cancer

 Risk factors
• Multifactorial interactions, including genetic,
environmental and psychological factors
• 80% of cancer is caused by poor lifestyle and
environmental factors.
-Among them, unreasonable diet, smoking and drinking
accounted for 35%,30% and 10%,respectively

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Cancer

 Risk factors
• Foods is the most direct, common and largest
amount of media that can contact between the
human body and the external environment and are
also the material basis of the structure,
microenvironment and metabolism of the body
• Diet and nutrition can affect the initiation,
promotion and progress of malignant tumors.

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Cancer

 Prevention
Between 30% and 50% of cancer deaths could be prevented by
modifying or avoiding key risk factors and implementing existing
evidence-based prevention strategies
• avoid tobacco use, including cigarettes and smokeless tobacco
• maintain a healthy weight
• eat a healthy diet with plenty of fruit and vegetables
• exercise regularly
• limit alcohol use
• practice safe sex
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Cancer

 Prevention
• get vaccinated against hepatitis B and human papillomavirus (HPV)
• reduce exposure to ultraviolet radiation
• prevent unnecessary ionizing radiation exposure (e.g. minimize
occupational exposure, ensure safe and appropriate medical use of
radiation in diagnosis and treatment)
• avoid urban air pollution and indoor smoke from household use of solid
fuels
• get regular medical care
• some chronic infections are also risk factors for cancer. People in low-
and middle-income countries are more likely to develop cancer through
chronic infections.
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Infectious diseases

 Definition
• Infectious diseases are illnesses caused by germs (such as bacteria,
viruses, and fungi) that enter the body, multiply, and can cause an
infection.
 Some infectious diseases are contagious (or communicable), meaning they are
capable of spreading from one person to another.
 Other infectious diseases can be spread by germs carried in air, water, food, or
soil. They can also be spread by vectors (like biting insects) or by animals to
humans.

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Infectious diseases

 Some infectious diseases are contagious (or communicable), meaning

they are capable of spreading from one person to another.
 Other infectious diseases can be spread by germs carried in air, water,
food, or soil. They can also be spread by vectors (like biting insects) or by
animals to humans.

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Infectious diseases

 A healthy immune system can protect the body from infectious

diseases, which acts as an integrated network consisted of immune
cells and tissues throughout human body.
 The nutrient fuels this immune system as the impetus to smooth its
function. But this kind of fuel is not the same as we usually
mentioned for energy-supply nutrients, which also includes some
non-energy-supply nutrients such as vitamins and minerals, which
can make the immune system work better and more smoothly.

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Infectious diseases

 A healthy immune system can protect the body from infectious diseases,
which acts as an integrated network consisted of immune cells and
tissues throughout human body.
 Nutrients can fuel the immune system protecting against infectious
disease
 The fuel is different from the usually mentioned energy-supply nutrients,
 Also includes some non-energy-supply nutrients such as vitamins and
minerals, making the immune system work better and more smoothly.

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Infectious diseases

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Source: Brown KH. Diarrhea and malnutrition. J Nutr 2003;133:328S-

32S
Infectious diseases

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Fan Y, Yao Q, Liu Y, Jia T, Zhang J, Jiang E. Underlying Causes and Co-existence of Malnutrition and Infections:
An Exceedingly Common Death Risk in Cancer. Front Nutr. 2022 Feb 23;9:814095.
Infectious diseases

 Malnourished patients have more infective and destructive viruses

compared with the well-nourished patients

 reasonable nutrition is a pivotal way to maintain the normal immune

functions and they are interacted

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Infectious diseases

 Nutrition support for infectious diseases

• Infectious diseases are illnesses caused by germs (such as bacteria,
viruses, and fungi) that enter the body, multiply, and can cause an
infection.
 Some infectious diseases are contagious (or communicable), meaning they are
capable of spreading from one person to another.
 Other infectious diseases can be spread by germs carried in air, water, food, or
soil. They can also be spread by vectors (like biting insects) or by animals to
humans.

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Thank you

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