Nutritional risk factors for type 2 diabetes quizlet,holistic treatment of diabetic neuropathy,ayurvedic treatment for diabetic wounds treatment - PDF Review


Good nutrition (getting enough of the right nutrients) is necessary for growth, and for physical and mental health. Vitamins and minerals are required by the body's cells and organs, and lack of particular vitamins or minerals can lead to illness or disease.
It is difficult to know how much poor nutrition is involved in the development of these diseases (whether poor nutrition has a large part or a small part), because there are so many other factors that play a part in the development of disease. In the past, as hunter-gatherers, Indigenous people needed to work together and be physically active when finding food. The hunter-gatherer method was the way of life of all humans until about 12,000 years ago, when human groups started to experiment with growing plants. Indigenous groups in Australia lived in many different climates and locations, varying from tropical to more moderate climates, from coastal to central areas. There is very little known about the health of Indigenous people before Europeans came to Australia, but it is understood that they were very healthy, fit and strong. Torres Strait Islander people generally ate more seafood than the Aboriginal people, because seafood was so easy to collect and was always available.
The hunter-gatherer lifestyle of Indigenous people changed after the arrival of Europeans in Australia in 1788.
Many Indigenous groups settled on cattle stations, government settlements or missions (run by religious groups) where they ate mostly European food.
This dependence on the European bosses gradually led to most Indigenous people converting to a ‘Western' diet, with much less physical activity involved.
The result of this was that many of the men were no longer working, leading to less physical activity, an increase in energy intake (food and alcohol), and continued lack of nutritious foods. The fast rate of change of the Indigenous diet has increased the risk of diet-related diseases such as obesity and non-insulin-dependent diabetes (also called type 2 diabetes or adult-onset diabetes). The effects of a mother's diet and nutrition when she is pregnant can have lifelong effects on her child.
Of particular concern is babies who do not weigh very much when they are born (known as ‘low birthweight'). A baby who has a low birthweight is at a higher risk of childhood death and many health problems. An Australian study done in 2005 showed that the average weight of babies born to Indigenous mothers was lower than that of non-Indigenous mothers (3158 grams for Indigenous babies and 3375 grams for non-Indigenous babies). A study was done in Darwin between 1987 and 1990 which looked at birthweights of 503 babies born to Aboriginal mothers.
To calculate BMI you need to know a person’s weight (in kilograms) and height (in metres). Measuring a child's growth is an important way to measure their overall health and development.
Charts of children's heights and weights have been produced by the World Health Organisation (WHO) and the US Centre for Disease Control.
Growth charts are developed by getting information on heights and weights of lots of children at different ages.
Healthy babies are more likely to grow into healthy adults, so encouraging good health early, through breastfeeding, is a wise thing to do. The Australian Dietary Guidelines for children and adolescents has ‘encourage and support breastfeeding' at the top of its list of guidelines.
These days Indigenous people have lower breastfeeding rates than non-Indigenous people (less Indigenous people breastfeed their babies), except for those still living in remote areas.
When a child is being weaned, the risk increases of them developing infections and malnutrition. For a long time the Australian government has recognised that there needs to be a strategy to encourage mothers to breastfeed for longer, and to promote appropriate foods for Indigenous infants. More recently (in 2007) the Australian Parliament had an inquiry into breastfeeding, with special attention on breastfeeding by Indigenous mothers. For a long time it was believed that this growth pattern was genetic, that it was the way all Indigenous babies grew. Studies in the 1970s and 1980s identified this same pattern of growth in Indigenous children in rural and remote areas of the Northern Territory and Western Australia. Results from this study in 1987-1989 showed a similar pattern of growth for Indigenous babies as was seen in the Kimberly, but after 11 years the growth of urban-dwelling children had improved while that of the remote children had not. The results of this study led the government in the 1990s to set up the Growth Assessment and Action (GAA) program. The most recent review by the GAA in April 2007 measured the growth of 3000 children aged less than five years (out of a total number of 4064 children), living in rural and remote communities.
According to the international organisation UNICEF (the United Nations Children's Fund), wasting rates of 10% or more require urgent action. Although there are many factors involved in the poor rates of growth of Indigenous children, the most important appear to be living in overcrowded, unhygienic conditions, with repeated infections and poor nutrition.
When the amount of food eaten by a person (measured as energy in kilojoules) is greater than the amount of energy being used (through daily activity and exercise) the extra energy is stored as fat and the person puts on weight. Obesity is often caused by eating too many refined carbohydrates (foods made from white flour or containing lots of sugar), drinking too much alcohol, and not getting enough exercise. A recent survey by the National Aboriginal and Torres Strait Islander Health Service (NATSIHS) in 2004-05 found that obesity is an increasing problem in the Australian Indigenous population. In the non-Indigenous population more than half the population (52%) was also found to be overweight or obese. The diets of many Indigenous people are high in energy, fat, refined carbohydrates and salt, and low in fibre and certain essential nutrients (such as folate, retinol and other vitamins).
The 2006 Census compares the employment status of Indigenous and non-Indigenous Australians.
The living conditions for many Indigenous people, especially those living in remote areas, are not very good. A discrete Indigenous community is a community with physical or legal boundaries, and one which is to be used by mostly Aboriginal or Torres Strait Islander people.
The freshness of the food and its variety are affected by the need for food to be stored suitably and protected from contamination. There has not been any information collected on cooking arrangements and food storage conditions in Indigenous communities, but these are thought to be ‘inadequate, and sometimes dangerous' for many Indigenous people living in remote areas. Many Indigenous people live in rural or remote areas where fresh, nutritious food is not always available, and the community store is the only place to shop. After long journeys in trucks, the food arrives in poor condition and some has to be thrown away. Those foods that don't need much or any preparation (and are less nutritious) are often preferred because they are convenient. A similar survey in the Northern Territory found that prices at remote stores were higher than in supermarkets and corner stores in Darwin.
Store managers have a big influence on what foods are available in remote Indigenous communities and so play a big part in improving the nutrition of the customers. The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 was developed as part of the nutrition strategy for all Australians called Eat Well Australia: a national framework for action in public health nutrition, 2000-2010. The federal government recognised that poor diet is a major reason why many Indigenous people have poor health and why so many Indigenous people suffer from chronic diseases.
Throughout their lives, many Indigenous people suffer from major health problems because of poor nutrition.
After birth most Indigenous babies grow well until they can no longer survive on breast milk alone. From the time they become young adults, many Indigenous people start to gain a lot of weight, eventually becoming overweight or obese. The main reason for these problems of growth and nutrition is the social disadvantage many Indigenous people experience, namely low levels of education, high levels of unemployment, low incomes and an unsatisfactory environment.
Two of the targets for ‘closing the gap' between the health of Indigenous and non-Indigenous Australians - to increase Indigenous life expectancy and to reduce child and infant mortality - are related to nutrition and diet.
Thirty years have been added to the average life expectancy of Americans over the past century. An evidence-based, prevention-oriented, population-wide life cycle approach to preserving health includes strategies for both the general population and those at high risk of disease.
The periconceptional use of folic acid to prevent neural tube defects (NTDs) is a good example of the importance of early nutrition, even before birth, playing a role as a factor governing future health. Because of studies such as these, in 1992, the US Department of Health and Human Services recommended the use of folic acid to reduce the number of cases of neural tube defects, estimating that 50% of neural tube birth defects could be prevented if women of childbearing age consumed 0.4 mg folic acid daily (9).
Although effective primary prevention strategies are optimal for promoting human health, secondary prevention, or risk reduction, is also important.
As defined by the World Health Organization, osteoporosis is the gradual decline in bone mass with age, which leads to increased bone fragility and fractures (14).
Peak bone mass is fully established by 30 y of age, but most of the increase in bone mass is achieved in adolescence during the growth spurt (16). Cardiovascular disease risk factors, such as obesity, type 2 diabetes, hypertension, and hyperlipidemia, have been reported even in children and adolescents (10-13, 19, 20).
Diet and exercise interventions can have a beneficial effect on body weight, body mass index, serum cholesterol, and fitness in children (25-31), as shown in the Child and Adolescent Trial for Cardiovascular Health (CATCH) Project, the largest school-based program to examine CVD prevention and risk reduction strategies in children (32). Most National Institutes of Health (NIH) recommendations are population-based, and especially rigorous assessment of the scientific evidence is needed for such population-wide recommendations. A life cycle perspective, together with an evidence-based approach to the decision-making process of choosing effective interventions that are well supported by evidence, is required to start on the path, stay on the path, and optimize the potential for healthier old age through effective intervention measures. When evaluating the evidence supporting a link between current nutrition, past nutrition, and disease in later life, the totality of the evidence must be carefully considered, even when the application is an intervention already in common use.
Several initiatives aimed at developing evidence-based prevention and treatment strategies for nutrition interventions in aging Americans have been undertaken lately with good result. The Institute of Medicine at the National Academy of Sciences, and Health Canada developed the new Dietary Reference Intakes (DRIs) with funding from the NIH and other groups (41, 42). The NIH has also examined several commonly used interventions of unproven or unquantified benefit and evaluated them for their relative utility.
Ideally, evidence gives rise to advocacy on the part of those who desire to obtain or provide some service, and this gives rise to action. High-risk and especially population-wide approaches are both important to decrease mortality and morbidity and extend healthy living into old age. A prevention-oriented, life cycle approach reduces the population's disease risk status with primary prevention strategies, such as proper nutrition.
The social implications of more people living longer revolve around quality of life, health status, and resource requirements of an increasingly aged population. The many benefits of nuts and seeds make them a welcome addition to our nutritional regimes, but for people who struggle with weight problems, the high amount of calories are a deal-breaker. Scientists conducted a 12-week long study of 283 participants, including 158 men and 125 women who had all been diagnosed with metabolic syndrome and demonstrated abdominal obesity and high cholesterol, blood pressure and blood sugars.


At the end of the study, researchers found that all 3 groups consumed more protein and fat while their carbohydrate intake decreased.
In short, researchers determined that using flaxseed and walnuts can help reverse the indicators of metabolic syndrome, particularly abdominal obesity, particularly when used in conjunction with lifestyle counseling.
Walnuts and flax seed are two of the highest vegetarian sources of omega-3s,  which also reduce inflammation and may help lower risk of chronic diseases such as heart disease, cancer, and arthritis.
Proteins, fats and carbohydrates are used by the body in everyday general activities, as well as assisting our bodies to recover from injuries or illness. These other factors include behaviour, the environment in which a person lives, and what genes a person has inherited from his or her parents.
Changing to a European diet and lifestyle has changed all this, and has caused problems for many Indigenous people with healthy, affordable food often being difficult to get. The men mostly hunted the large animals, while the women collected the small animals and plants. The traditional diet was high in protein, complex carbohydrates (those that are digested slowly) and nutrients, and low in sugars.
They were very knowledgeable about the sea, about the feeding patterns of the animals, tidal movements and such like. When their traditional lands were taken over by farmers and graziers, many Indigenous people were forced to live in settlements and to get food and other necessities from the Europeans. One result of this was that mothers had less responsibility for feeding their own children and lost a lot of the knowledge they had about food and feeding. Women no longer needed to gather and prepare the food and spent more time sitting around camps and settlements.
The change has been from a fibre-rich, high protein, low-saturated-fat traditional diet to one high in refined carbohydrates (like white flour where most of the nutrients have been removed during processing) and saturated fats (which come from animal foods). It also found that Indigenous mothers are more likely to have low birthweight babies than non-Indigenous mothers. The study looked at the babies of mothers who were underweight, that is had a body mass index (BMI) of less than 18.5 (see box for an explanation of BMI). BMI can tell you whether a person is under weight, has a healthy weight, is overweight or is obese.
From 2001-2004, babies born to Indigenous women who smoked were, on average, lighter than babies born to Indigenous women who did not smoke (3037 grams compared with 3290 grams).
These can be used to follow a child's growth and weight over years to see whether they are developing as expected.
The child can then be identified for treatment to improve their nutrition, which leads to better growth and improved long-term health.
Information from whole populations can be used to work out the ‘usual' weight or height of children at a particular age. The recommendations are that babies should be breastfed only (no food) for the first six months, with breastfeeding continuing to 12 months or beyond along with solid food. In some Indigenous communities where living conditions are not very hygienic or there is a lot of contamination (e.g. Studies carried out in the 1980s, however, showed that Indigenous children brought up in good living conditions showed similar growth patterns to non-Indigenous Australian children. The aim was to collect information (height, weight, and health information) on Indigenous babies born in NT from 1987 to 1989 and to continue to collect information over a long period of time (after 11 years, 20 years and 25 years). The GAA keeps track of the growth of Indigenous children up to five years of age in about 80 remote communities in NT and takes action if the growth rate seems to be falling. Excess body fat leads to being overweight (a bit too much fat) or being obese (too much fat). It can lead to high insulin, cholesterol, lipid and blood pressure which are all risk factors for heart disease.
Over a quarter (28%) of Indigenous people aged 15 years or older were overweight and over a quarter (29%) were obese.
The main difference between the two populations was the greater proportion of obese Indigenous people (29%) than non-Indigenous people (17%). Their homes are overcrowded, they do not have safe, clean drinking water, the plumbing is not safe, there is little room to store food, and no proper equipment to cook it on.
This means that if there is no refrigeration fresh meat and milk will not be available, only canned meats and long-life milk.
In many cases the store gets new supplies only once a week, or, as in some areas of the Torres Strait, even less often than that. The fruit and vegetables are less popular because they have been bruised and damaged during the trip, and also need more preparation. A project at Minjilang (Croker Island, Northern Territory) showed that improvements of this kind only work when the community members are involved.
Both strategies were endorsed (put into action) by the Australian Health Ministers' Conference in August 2001. Being overweight or obese is linked to many chronic diseases, especially cardiovascular disease and diabetes.
However, improvements in nutrition will need to be accompanied by improvements in social disadvantage (mentioned above). Excluded material owned by third parties may include, for example, design and layout, images obtained under licence from third parties and signatures.
Address correspondence to J Dwyer, Friedman School of Nutrition Science and Policy and School of Medicine, Tufts University, Box 783, Tufts–New England Medical Center, 750 Washington Street, Boston, MA 02111. It is a reasonable expectation that Americans will achieve an average life span of 100 y within this century.
Paradigms that promote the nutritional components of healthy aging are needed to increase the age of chronic degenerative disease onset and to maintain healthy, functional lives for as long as possible. The preventive approach identifies those who have markers of susceptibility but who do not yet have the disease and focuses on prevention. Randomized controlled trials and case-controlled studies of women with or without a prior pregnancy affected by NTD have shown that folic acid supplements during the periconceptual period significantly reduce the risk of further NTD-affected pregnancies (4-8). However, it is complex, particularly when it involves chronic degenerative diseases that are caused by multiple factors.
The life cycle approach to disease prevention, which highlights the interactions between genetics, environment, and the effects of time in considering how the development of age-associated chronic diseases may be influenced. Osteoporosis is estimated to affect 10 million Americans and will affect 14 million by 2020 (15). Age affects mean calcium retention, with maximal retention occurring in early puberty followed by a marked decline in late puberty (17). A 1994 US Department of Agriculture survey found that in women, the average daily calcium intake fell below the Recommended Daily Allowance from the age of 11 y onward (Figure 2) (18). Mean calcium intakes as percentages of the 1989 Recommended Dietary Allowances (RDAs) by sex and age, 1994.
These risk factors include excessive intake of food energy, dietary saturated and other fats, and cholesterol coupled with physical inactivity (21, 22). In CATCH, maintenance of light weight (body mass index <15th percentile) was associated with the most favorable pattern of cardiovascular disease risk factors, and maintenance or achievement of light weight was associated with favorable changes in systolic blood pressure during early adolescence, despite the lower-than-expected prevalence of light weight (34). Clearly, identifying those at risk and implementing preventive measures via nutrition and other measures is required to shift the population to one with a reduced disease risk status.
This requires disseminating information and implementing interventions to the entire population to help all individuals continue to live healthy lives.
But what is the best paradigm for evaluating this evidence to determine the best course of action?
A paradigm to evaluate research to produce a consensus statement surrounding a particular topic. An especially strong evidence base for prevention and treatment decision-making in nutritional intervention is needed if national programming is the objective. Support for such caution about assuming that widespread practices are effective comes from the Women's Health Initiative.
The American Academy of Family Physicians, the American Dietetic Association, and other professional nutrition, health, and social welfare societies conjointly launched the Nutrition Screening Initiative in the early 1990s (39), which institutionalized the concepts of nutrition screening and intervention in the health care of older Americans and specifically addressed 8 chronic degenerative diseases (40). The DRIs now include specific nutrient standards for individuals aged >70 y, because it is clear that nutrient requirements change in aging adults as the result of physiologic, functional, and lifestyle changes.
In recent years, these reviews have included n–3 fatty acid use in osteoporosis (43) and CVD (44). In real life, however, the process is more convoluted and recursive, with evidence and advocacy influencing action or treatment at many parts of the process.
Once the evidence is produced and validated, advocacy is again needed to move the argument for the intervention or treatment forward through public policy and decision-making.
A: The ideal scenario for the development of the treatment process involves using evidence to give rise to advocacy, which in turn leads to action.
With a focus on and adequate resources available to implement prevention-oriented, life cycle approaches that successfully reduce risk, delay chronic disease onset, and mitigate nutrition-related morbidity in disease, it should be possible to achieve the desired outcomes. Research looked into the effects of flaxseeds and walnuts on metabolic syndrome because they are high in omega-3 polyunsaturated fats and fiber. Participants were organized into three groups, one group replaced staple foods such as rice and bread with bread containing an ounce of flaxseed,  a second group replaced the same staple foods with bread containing an ounce of walnuts while the third group was a control group and were not directed to make any specific dietary changes. Participants in both the flax and walnut groups ate more polyunsaturated fats and fiber than the control group. You will personally receive a newsletter each week from Peter with nutrition and exercise tips. Those living in coastal areas were less likely to move around because food was always plentiful. In places where there was plenty of food and water large groups might camp for weeks or months before moving on.
The types of foods that were eaten depended a lot on where the people were living and the time of year. The foods available in the Torres Strait varied between the islands, and the Islanders depended partly on simple forms of agriculture and trade. Other groups that have been through similar rapid lifestyle changes include the Pima Indians and Native Americans.
Almost double the number of women who smoked had low birthweight babies compared to women who didn't smoke, in both Indigenous and non-Indigenous women. If necessary, other women who were also breastfeeding could feed a child whose mother could not feed for some reason. This type of study, known as a longitudinal study, allows the researchers to investigate causes of diseases and other health issues. By providing a wider variety of healthy foods and healthy ideas in their stores, the store owners also benefit by selling more of these products.
Sometimes what they are given is not enough or not healthy, or perhaps is contaminated if they live in areas where there is inadequate housing, no sewerage, or no fresh water.


The most dramatic decreases in early-life and midlife mortality coincided with advances in medicine; curative medicine has played a lesser role.
Relatively healthy Americans who are currently aged 75 y may expect to live to an average of 86.5 y (2). Keeping as many people as possible free of risk (primary prevention), keeping those already at risk at the lowest risk possible and delaying disease onset (secondary prevention), and treating those who are already diseased to mitigate disease progression (tertiary prevention) are all levels at which interventions can be made to prevent further morbidity. Taking those at risk and reducing that risk to delay or avoid disease onset for as long as possible becomes the focus. Failure to achieve optimal bone mass at the end of adolescence leaves an individual with less reserve to withstand normal losses in bone density that occur during later life (15). Dietary intervention in childhood is critical to increase peak bone mass and calcium reserves that can help to limit the rate of bone loss in later years (15). Adapted from the US Department of Agriculture's 1994 Continuing Survey of Food Intakes by Individuals and 1994 Diet and Health Knowledge Survey (18). Compounding the situation is a "time bomb": the development of childhood obesity earlier in life is increasingly predictive of future obesity in adulthood (23, 24). In the intervention group, a decrease in the proportion of daily calories coming from saturated fats, although not reaching study goals, was achieved relative to a control group and was also sustained at follow-up 3 y later (32, 33).
In contrast, normal-weight children who became overweight during the course of the study exhibited striking and adverse percentage changes in serum cholesterol (increased) and in both serum HDL-cholesterol (decreased) and apolipoprotein B concentrations (increased) (34).
Trying to decrease excessive weight gain through nutrition and physical activity interventions will help those already overweight or obese and help prevent further weight gain (10, 11, 34). However, it is not always clear what people should be told to maintain and improve their health. One process used by the NIH to evaluate current evidence for making recommendations that affect many people in important ways is described in Figure 3. Although a theoretical rationale exists for nutritional intervention throughout the life cycle for all those at risk of or already living with chronic degenerative diseases, evidence for each possible measure is required to support population-wide nutritional recommendations.
Nutrition screening and interventions, when they are coupled with other effective therapies, are cost-effective and result in fewer complications, faster recovery, shorter hospital stays, and reduced hospital expenditures. A study of routine use of vitamin and dietary supplements for chronic disease prevention is also now in progress.
The Nutrition Screening Initiative actually stimulated a good deal of research on which later advocacy could be based, for example.
B: The real-life scenario is more convoluted, with evidence, advocacy, and action interacting throughout the process.
The goal of delaying disability in an increasingly longer life is valid, but the age of onset of chronic disease must be similarly delayed, or we will only achieve extended misery in those extra years.
Secondary and tertiary prevention involving a combined high-risk and population approach identifies those at high risk and protects or treats them, keeping as many as possible at low risk, and continues to shift the entire population to lower risk.
To bring this about, we must think about nutrition and other preventive measures early and often.
All three groups received lifestyle counseling based on the American Heart Association guidelines which advises participants to eat a low-fat diet, limit intake of red or processed meat, lower salt intake, eat more fruit and vegetables, quit smoking, and limit alcohol.
Some of these foods were highly processed (manufactured) so they could survive long periods of transport and storage, but they were often very high in fat, sugar and salt.
Individual children can then have their weight and height compared to these charts to see if they are less than, the same as, or greater than the charts. The traditional way was to breastfeed for up to four years, sometimes longer, gradually introducing nutritious bush foods. The aging of the population alone has already increased health care costs, and as we move toward even longer lives, these costs will likely increase even more. The rise in life expectancy over the past century has been linear, with no indication of an imminent decline in the rate of increase (3). How successful we are in doing it may ultimately determine the quality of life in very old age. Prevention is the key to healthy living: starting life healthy, staying healthy, and maintaining the lowest risk throughout life.
The life cycle approach to disease prevention acknowledges not only the importance of genetics and environmental influences, but also the effects of time in the development of chronic degenerative diseases (Figure 1). Risk factors for a low peak bone mass, and therefore an increased risk of osteoporosis, include low body mass index, low levels of weight-bearing physical activity, poor nutritional status due to low calcium and vitamin D intake, smoking, and genetic factors (15).
Otherwise, poor nutrition in early life will increase risks of future bone fragility and fractures occurring spontaneously or due to trivial injuries.
Mean calcium intakes in females were consistently below the RDA, particularly during adolescence when maximal calcium retention occurs.
The increased prevalence of these disorders in youth and young adults increases risks of premature morbidity and mortality and increased health care costs. Similarly, self-reported vigorous daily activity was higher in the intervention than in the control group (32).
Interventions to do this can only be identified by examining the totality of evidence by constantly updating and summarizing relevant findings. The pyramid represents the body of evidence, where the large base houses weaker evidence but denotes the abundance of it.
Continuous evaluation and updating of the evidence is also required to continue down the correct path as more data accumulate. This popular and commonly used therapy among postmenopausal women failed to prevent heart disease.
The arm of the Women’s Health Initiative that is evaluating the potential of calcium supplements to reduce the risk of osteoporosis in postmenopausal women will soon be completed (45). Finally, policymakers need to review the evidence before making decisions and action occurs.
There is questionable merit, both for the individual and for society as a whole, in adding life to years if those incremental years are spent in poor health and misery. The ultimate objective is to achieve more years of life with minimal years of compromised health. Abdominal obesity decreased the more in the flax and walnut groups, while serum glucose was also lower in the flax group.
When they did not receive enough food from their bosses, the Indigenous people would collect bush foods.
This can develop into a vicious cycle: the children are undernourished so their bodies cannot fight the infections, so they get sick, and when they are sick they are at risk of getting more infections because the food they eat is not making them strong enough to fight the infections.
Therefore, establishing and safeguarding optimal health from early life must become increasingly important concerns for governments and health care providers if they are to allocate resources wisely and ensure and maintain a high quality of life in the population.
Therefore, it is reasonable to expect the average life span in the United States to reach or exceed 100 y in the 21st century. The high-risk approach focuses on those who already have the disease and treats them to prevent further morbidity.
In developing countries today, even poor children are displaying chronic degenerative disease risk factors such as obesity (10, 11) in addition to deficiency diseases. However, although intervention children sustained higher levels of activity than did the control children, levels of activity steadily declined for both groups of children over the next 3 y (33).
An evidence-based approach allows evaluation of the data needed to choose the appropriate interventions and ultimately guide actions. As we climb up through each level of the pyramid, the quality of evidence improves but the quantity of studies available is inevitably reduced, because they are time-consuming and expensive to accomplish. In 2002, the NIH stopped the estrogen plus progesterone trial because of increased risks of venous thrombosis and CVD (35, 36).
We do this by starting on the right path, staying on the right path, and dying young as old as possible. A prevention-oriented, life cycle approach is critical to establishing and maintaining health throughout life. However, because the average age at chronic disease onset has not risen to the same extent as life expectancy, a typical American currently aged 75 y can look forward to only 4 more years of active health followed by >7 y of disability (2). Even some diseases previously considered adult-onset, such as type 2 diabetes and hypertension, are also evident (12, 13).
The intervention was not strong enough to prevent the encroachment of increasingly sedentary lifestyles.
The NIH has developed a process whereby all information in the evidence pyramid is considered and weighed to help develop a consensus judgment on its strength through an unbiased review process. In 2004, the estrogen-alone trial was stopped because of negative effects on cognitive function and dementia, increased risk of stroke, and lack of effect on coronary artery disease incidence (37, 38). This in turn can mean that mothers are not as strong and healthy as they could be, and this will have a bad effect on their babies. This approach can delay and compress morbidity and the social toll associated with chronic disease and disability for as long as possible into old age.
If the age of chronic disease onset does not increase commensurate to the added years of life still to come, a growing number of centenarians will spend the last 2 decades of their lives living with the serious and debilitating consequences of chronic disease. Starting life in a suboptimal unhealthy environment that does not support growth, be it an environment caused by poor diet or some factor in the built, social, or natural environment, may also increase the risk of future chronic degenerative disease development.
The consensus statement produced summarizes what is known and also addresses needs for future research.
Evaluating the evidence about HRT from this study has led to action and changes in prescribing patterns as well as in women's acceptance of these therapies. Nor do the programs that do the most good necessarily get the credit or the budgets they deserve.
Good evidence exists that early nutrition affects key risk factors for chronic degenerative diseases of middle and later life, such as osteoporosis and cardiovascular disease. Osteoporosis and cardiovascular disease (CVD) are 2 examples of diseases that exhibit cobwebs of risk factors that must be prevented and controlled starting early in life. New data feed back into the evidence pyramid until the data are conclusive enough to permit population recommendations to be made. For example, in the 20th century, public health advances delivered most of the 30 additional life-years we now have, but for the past several decades, most of the public health budget has gone to the discovery of new and costly therapies (3). The influence of nutrition on health status and morbidity supports primary, secondary, and tertiary prevention of disease and intervention strategies at each point in the process. Given the potential for a prevention-oriented, life cycle approach to reduce disease risk across populations, delay or prevent chronic disease onset, and reduce the morbidity associated with such disease, budgets may need readjusting to accommodate more such public health initiatives. The objective of such a prevention-oriented model is to enable people to live well for longer, while minimizing chronic disability.
Starting down the right path with appropriate nutrition and staying on it by eating well are important components of healthy aging.



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