‘Nutrition and Health’

This essay will evaluate the impact of diet upon health and wellbeing in relation to: the nutritional requirements of pregnant women; the changing energy requirements across the lifespan, with reference to the obesity crisis in England; Type Two diabetes; and cardiovascular disease. [^]

Pregnant women have an increased need for certain nutrients during pregnancy, specifically: folic acid; riboflavin (0.3 milligrams/day); vitamin A (100 micrograms/day); vitamin D (10 micrograms/day); and, during the last trimester, thiamin (0.1 milligrams/day) and vitamin C (10 milligrams/day) (British Nutrition Foundation, 2016). Advice from NHS Choices suggests that women should take a folic acid supplement to ensure that they obtain 400 micrograms of folic acid daily from before conception up till the twelfth week of pregnancy (NHS Choices, 2017a), since a lack of folic acid prior to pregnancy and in the early stages of pregnancy is the most significant risk factor for spina bifida and other neural tube defects (NHS Choices, 2015). The British Nutrition Foundation (2016) stipulates a need for an additional daily 100 micrograms of folic acid throughout pregnancy. Riboflavin is used by the body to maintain the health of the skin, eyes, and nervous system, and must be included in the daily diet as it cannot be stored in the body (NHS Choices, 2017b). Thus, pregnant women should ensure that they eat an adequate amount of foods such as eggs, rice, and fortified cereals. Similar to riboflavin, vitamin A helps to ensure correct immune system function and good skin health, as well as aiding vision in dim light. Eating foods such as cheese, eggs, oily fish, fortified low-fat spreads, and yoghurts will provide pregnant women with sufficient vitamin A (NHS Choices, 2017c). Vitamin D is synthesized in the body by the action of sunlight on 7-dehydrocholesterol in the skin, and most people will obtain sufficient vitamin D from sunlight between Easter and late September (Grant and Waugh, 2014). Pregnant women can meet their additional vitamin D requirements by eating an adequate amount of oily fish, red meat, egg yolks, and fortified foods (NHS Choices, 2017d). Thiamin helps to energize the body via food catabolism, and it also helps to maintain good nervous system health. It is found in peas, fresh and dried fruit, eggs, wholegrain breads, and some fortified breakfast cereals, so pregnant women can easily obtain their additional thiamin requirement by consuming these products (NHS Choices, 2017b). As with riboflavin, vitamin C cannot be stored in the body so it must be part of the daily diet. Pregnant women should ensure that they consume an adequate amount of oranges, red and green peppers, strawberries, broccoli, Brussels sprouts, and potatoes in order to meet their increased vitamin C requirements. This will ensure cellular health and protection, promote healthy skin, blood vessels, bones, and cartilage, and safeguard wound healing efficacy (NHS Choices, 2017e). [^]

Pregnant women also have increased protein and calorie requirements. The daily adult protein requirement (in grams) is calculated by multiplying weight (kilograms) by 0.75. Since the average British adult female weighs 11 stone (69.85 kg) (Daily Mail, 2016), the average protein requirement for a British adult female is 52.39g (69.85 x 0.75); this daily protein requirement increases by six grams per day during pregnancy (British Nutrition Foundation, 2016). As well as an increased protein requirement, pregnant women require 200 extra calories per day during the last trimester (British Nutrition Foundation, 2016). The fact that energy requirements are only increased during the final three months of pregnancy differs from the commonly-held view that pregnant women are ‘eating for two’; this view has led to a third of women gaining a ‘medically excessive’ amount of weight during pregnancy (Hammond, 2012). Being overweight – defined as a Body Mass Index [BMI] in the range of 25-29.9 – or obese – defined as a BMI of 30 and above (NHS Choices, 2016a) – increases the risk of a number of pregnancy complications, including miscarriage, gestational diabetes, pre-eclampsia, blood clots, shoulder dystocia, post-partum haemorrhage, and giving birth to a baby weighing in excess of 8lb 14oz (NHS Choices, 2017f). [^]

As well as proving problematic during pregnancy, obesity is currently a major societal health issue in England. Bodyweight is governed by the ‘energy balance equation’, a relationship defined by the laws of thermodynamics that state that energy is never really created nor destroyed, merely transferred. Energy provided by food is measured in calories; this energy intake is balanced against the energy used by the body for maintenance and rest, physical activity, and food digestion, storage, and transport (Andrews, 2017). Weight gain occurs when calories consumed exceeds energy expenditure; weight maintenance occurs when calories consumed is equal to energy expenditure; and weight loss occurs when calories consumed is less than energy expenditure (National Institutes of Health, 2013). Prolonged consumption of calories surplus to the body’s requirements will result in an individual becoming overweight, then obese, and eventually morbidly obese [defined as a BMI of 40 or above (NHS Choices, 2016a)]. BMI is calculated by dividing weight (in kilograms) by height (in metres), then dividing the result by height (in metres) again (NHS Choices, 2016b). 63% of English adults are classed as obese (27% of total) or overweight (36% of total) (Baker, 2017). Therefore, nearly two-thirds of the adult English population consistently consumes calories in excess of bodily requirements. The highest incidence of overweight and obese individuals is apparent in the age ranges 55-64, 65-74, and 75-84, with between 71-75% of the population thus classified. Conversely, the adult age group with the smallest number of overweight or obese individuals is that of 16-24-year-olds, with 53% at a normal weight and only 36% in excess of normal weight (Baker, 2017). This is perhaps down to the fact that daily calorie requirements slowly decrease throughout the lifespan from a peak at aged 18 (3155 for males, 2462 for females) to a nadir for individuals aged 75 and over (2294 for males, 1840 for females) (British Nutrition Foundation, 2016). Since significant weight gain occurs after prolonged consumption of calories in excess of the body’s requirements, one would expect comparatively fewer children in the 4-5 age range to be classed as overweight or obese, and this is borne out by the statistics that show that 22% of these children are overweight (of which 9% are obese). Amongst 10-11-year-olds this figure rises to 34% (of which 20% are obese) (Baker, 2017). This rise could be down to the fact that children’s protein requirement increases from 19.7g/day aged 4-6 to 28.3g/day aged 7-10 (British Nutrition Foundation, 2016). In the absence of a sensible diet containing an adequate, satisfying amount of protein, children might snack more regularly on higher-calorie, higher-fat foods. For example, a tuna sandwich as part of a school lunch provides 15g protein (MyFitnessPal, 2017a), whereas a chocolate spread sandwich provides 0g protein (MyFitnessPal, 2017b). The child might still feel ‘hungry’ after the chocolate spread sandwich, and be more inclined to snack later in the day in the hope of fulfilling this protein requirement. In simple summary, the incidence of excessive weight becomes more prevalent as the population ages. [^]

In order to lose weight, individuals have to consume fewer calories than they expend. Engaging in regular exercise such as fast walking, jogging, swimming, or tennis for 2.5-5 hours per week will help to use calories (NHS Choices, 2016a), and making the correct dietary choices will complement this effort. Meals should be based on starchy carbohydrates, since these carbohydrates contain less than half the calories of fat (NHS Choices, 2016c). Eating five portions of fruit and vegetables per day can help induce a feeling of satiety owing to the fibre content of these foods, meaning individuals are less likely to snack on high fat, high sugar foods such as chocolate and cakes (Weisenberger, 2015). Cutting down on saturated fat – found in foods such as hard cheese, cakes, sausages, lard, and pies – and minimizing the amount of sugar consumed from products such as fizzy drinks, alcohol, and pastries will help with weight management and dental problems, as well as ensuring that the guideline for saturated fat intake is not exceeded [30g/day for an adult male, 20g/day for an adult female (NHS Choices, 2016c), and no more than 11% of daily food energy for all ages (British Nutrition Foundation, 2016)]. Fish should be eaten at least twice a week, one portion of which should be oily, and salt intake should not exceed 6g/day for adults and children over 11 (NHS Choices, 2016c). The synergistic interaction of exercise and correct dietary choices can help individuals to control their weight, leading them away from a medical classification of obese or overweight and, therefore, away from obesity’s myriad comorbid health complications. [^]

One such comorbid health condition is Type Two diabetes (Guh et al., 2009). Insulin is secreted by pancreatic beta cells, facilitating the movement of glucose into body cells – from where it is converted to energy (Grant and Waugh, 2014). If the pancreas is unable to produce sufficient insulin, or the body is unable to utilize the insulin produced, Type Two diabetes will result. Being overweight or obese is a major, controllable risk factor for Type Two diabetes, along with other, uncontrollable risk factors including ethnicity, age, and genetics (NHS Choices, 2016d). The lack of cellular glucose uptake leads to hyperglycaemia – elevated levels of blood glucose – which in turn causes the main symptoms of diabetes, namely: frequent urination; extreme thirst; fatigue; unexplained weight loss; genital itching and infection; slow wound healing; and blurred vision (NHS Choices, 2016e). [^]

Similar to obesity treatment, dietary advice for Type Two diabetics focuses on eating a healthy, balanced diet with a long-term view to minimizing saturated fat, sugar, and salt intake, while eating regularly and consuming five portions of fruit and vegetables per day (Diabetes UK, 2017a). Since carbohydrates begin digestive life as polysaccharides and are absorbed into the bloodstream in the form of saccharides [single molecule sugars] via enterocytes covering the villi of the small intestine (Vivo Pathophysiology, 2017), a diabetic must closely monitor the amount and type of carbohydrates consumed – making wise carbohydrate choices as often as possible, for example: whole grains; pulses; and fruits and vegetables (Diabetes UK, 2017b). Lower-GI carbohydrates – whole wheat pasta, wholegrain bread, olives – are useful in helping a diabetic to control their blood glucose, since the slower absorption of glucose from these types of carbohydrates does not induce the dangerous spikes in blood glucose levels associated with high-sugar, high-GI products such as honey, bagels, white bread, potato chips, and beer (The Ingredient Store, 2010). Since people with Type Two diabetes are up to five times more likely to develop cardiovascular disease, it is important to make correct and sustained dietary and lifestyle choices (NHS Choices, 2016f). [^]

Being overweight or obese and having Type Two diabetes are two major risk factors for cardiovascular disease (NHS Choices, 2016g). A further risk factor is high blood pressure, whereby an unhealthily high amount of force is required to pump blood around the body owing to the high level of resistance to the blood flow in the blood vessels (NHS Choices, 2016h). Cardiovascular disease is usually associated with atherosclerosis, a condition whereby a build-up of fatty deposits causes the arteries to narrow and harden, increasing the risk of blood clots and restricting the blood flow and oxygen supply (NHS Choices, 2016i). Restricted flow of oxygen-rich blood to the heart muscle can lead to angina, heart attacks, and heart failure. Temporarily restricted blood flow to the brain can lead to a transient ischaemic attack (‘mini-stroke’), whilst a prolonged disruption of blood flow to the brain leads to a stroke, which can cause brain damage and death. Peripheral arterial disease will result if the arteries feeding the limbs become blocked, while a build-up of fatty deposits in the blood vessel carrying blood from the heart to the rest of the body leads to aortic disease (NHS Choices, 2016g). [^]

As well as making healthier lifestyle choices – including stopping smoking and taking regular exercise – the risk of cardiovascular disease is reduced by eating the same healthy diet as outlined above in relation to treating obesity, and which applies equally to the treatment of Type Two diabetes. Alcohol should be consumed in moderation, not exceeding the 14 units/week recommendation (NHS Choices, 2016g), since it can be high in calories and carbohydrates – one pint of lager contains approximately 233 calories and 17.6 grams of carbohydrate (Weight Loss Resources, 2017a) while one 125ml glass of red wine provides roughly 85 calories and 3.1 grams of carbohydrate (Weight Loss Resources, 2017b). Since carbohydrates enter the bloodstream as glucose (thus raising blood glucose levels), and glucose in excess of the body cells’ storage capacity is transported to the liver by insulin and converted to triglycerides for storage in the bodily fat depots (Kolodziejski, 2017), excessive alcohol intake will have detrimental health effects in relation to obesity, Type Two diabetes, and cardiovascular disease. [^]

In conclusion, diet is of paramount importance to health and wellbeing. Poor dietary choices during pregnancy result in an overweight or obese mother and an unhealthy baby. Ill-considered food consumption has led to approximately one fifth of 4-5-year-olds and one third of 10-11-year-olds being medically overweight or obese. Continuing with an unwise diet into adulthood significantly increases the likelihood of obesity, Type Two diabetes, and cardiovascular disease. [^]