NUT201 - Chapter 3 Diseases Spring 2023

NUT201: Fundamentals of Human Nutrition
Chapter 3:
Nutrition-Related Health Conditions
Learning Outcomes
1.Recall the epidemiology and pathophysiology of
selected nutrition-related health conditions
2.Understand the link between nutrition and selected
health conditions
3.Outline the medical nutrition therapy of selected
nutrition-related health conditions
Part 1:
Diabetes
Diabetes
• Chronic disease characterized by

elevated blood glucose concentrations
• ≈1/2 of those suffering from diabetes
are not aware of their condition!
International Diabetes Federation, 2022

Regulating Glucose
Regulating Glucose
Secreted as blood glucose 
such as after a meal
Insulin Signals the muscle & liver
The body mainly cells to store excess
controls blood glucose as glycogen
glucose through 2
Secreted as blood glucose 
hormones such as in prolonged fasting
Glucagon
Signals the breakdown of
liver glycogen into glucose
 Adrenaline: secreted in times of anger or fear; it signals the breakdown of liver

glycogen into glucose → increase blood sugar levels (same effect as glucagon)
Symptoms & Complications
Symptoms Complications
Neuropathy
Polyuria
Retinopathy
Polydipsia
Nephropathy
Polyphagia
Cardiovascular diseases
Types and risk factors
Type I: (10-20%) No insulin production by pancreas
• Leading chronic disease among children and young adults
• External insulin source is needed: Insulin shots/inhalers
• Risk factors: family history, autoimmune diseases
• Preferred therapy: Weight loss and lifestyle changes, followed/combined with pharmacoth
erapy
Type II: (≈ 90%) Does not respond to insulin
• Glucose uptake is slower than normal (Insulin Resistance)
• Risk factors: Obesity, family history, physical inactivity, history of gestational diabetes, etc.
• Preferred therapy: Lifestyle changes combined with pharmacotherapy
Other types:
• Type 1.5
• Gestational diabetes
Management
 Promote weight loss for overweight and obese
 Prioritize carbohydrate intake from vegetables, fruits, whole grains,
legumes, and dairy products over other sources, especially those that
contain added fats, sugars, or sodium
 Limit added sugars to <10% of calories per day [avoid Sugar Sweetened
Beverages (SSB): soft drinks, fruit drinks, energy drinks]
 Increase fiber intake
 Reduce saturated and eliminate trans fats (worsens insulin resistance
and heart disease)
 No ideal percentage of calories from carbohydrate, protein, and fat
for all persons with diabetes
 Increase exercise as it aids in weight management and  insulin
sensitivity)
 Consider medications (oral hypoglycemic and/or insulin)
Part 2:
Cardiovascular Diseases
• Refer to a group of disorders of the heart and blood vessels (e.g.
coronary heart disease, cerebrovascular disease, etc.)
• Leading cause of mortality worldwide

• Associated with the death of 17.9 million lives each year
• >75% of CVD deaths are associated with heart attacks and stroke
• 33% of deaths are in people <70 years of age
3 major risk factors for CVD:
1. Elevated Blood Cholesterol
2. Smoking
3. Hypertension
Injury / Damage in the lining of arteries
Build Up of Plaque
(made up of fat, calcium, and cholesterol)
Narrowing of arteries: Atherosclerosis

Development of CVD
Narrowing of
Blood Flow Stroke/ Heart
arteries
Blocked attack
Atherosclerosis
Management
✓Encourage consumption of a dietary pattern that emphasizes intake of
vegetables, fruits, and whole grains; includes low-fat dairy products,
poultry, fish, legumes, nontropical vegetable oils and nuts; and limits intake
of sweets, SSBs, red and processed meats
✓Promote achievement of a healthful body weight and energy balance
✓Limit intake of Saturated to 10% of total energy
✓Eliminate Trans Fat
✓Incorporate Physical Activity: 3-4 sessions/week, 40 minutes/session, moderate-
to-vigorous intensity
Hypertension
Chronic elevation in blood pressure
• HTN occurs in ≈1 out of every 3 adults
• ~⅓ of adults are unaware of their HTN (asymptomatic, silent)
(Najem;Halawi et al., 2021; Carey;Whelton et al., 2018)

Risk Factors
• Genetic predisposition
• Age
• Ethnicity
• Obesity
• Smoking
• Lack of physical activity
• Salt sensitivity
• Alcohol
• Diet low in fruits, vegetables, nuts, potassium, calcium; high in fat
• Medications: Corticosteroids; Estrogens; Non-steroidal anti-inflammatory drugs…
Complications
If untreated, chronic high blood pressure may lead to:
• Cardiac failure
• Myocardial Infarction
• Stroke
• Kidney disease
• Vision problems (retinopathy)
Management
Dietary Approaches to Stop Hypertension (DASH)
• Emphasizes intake of vegetables, fruits, and whole

grains; includes low-fat dairy products, poultry,
fish, legumes, nontropical vegetable oils and nuts;
and limits intake of sweets, SSBs, red and
processed meats
• Limits alcohol
• Decreases sodium intake
• Promotes modest, sustained weight loss if overweight,
obese
• Incoporate PA: aerobic, 3-4 sessions/week, 40
minutes/session, moderate-to-vigorous intensity
Part 3:
Lactose Intolerance
Lactose Intolerance
 Loss of the ability to produce enough of

the enzyme lactase (produced in the
small intestine) to digest the milk sugar-
lactose
 Risk factors
 Age
 Ethnicity
 Premature birth
 Conditions affecting the small intestine
 Previous radiotherapy
Symptoms & Complications
Symptoms
 Gas
 Bloating
 Cramps
 Pain
 Diarrhea
Complications
 Malnutrition
 Osteopenia
Dietary Management
 Many people with lactose intolerance can consume moderate

amounts of lactose (1/2-1 cup of milk)
 Lactose is better digested when combined with other foods as

they delay digestion, giving more time for lactase action
 Hard cheeses and yogurt are more tolerated

Lactose Content in Dairy
Dietary Management
 It is important to include calcium-rich

substitutes to milk such as:
➢ Low lactose milk
➢ Plant-based milk fortified with Calcium
and Vitamin D
➢ Dark-green leafy vegetables
➢ Canned sardines
 Individuals may opt to use lactase pills
Part 4:
Osteoporosis
Osteoporosis
Reduction in the bone mass of adults causing bones to become
porous & fragile
– To protect against these losses, high
calcium intake and adequate Vitamin D
in early life is recommended to achieve
peak bone mass
– Peak bone mass is the highest

attainable bone density for an individual
(developed during the first three
decades of life)
Healthy Bone Osteoporotic Bone
Bone Mineral Density
Risk factors
• Age, especially older than age 60
• Gender (more likely in females)
• Physical inactivity
• Inadequate calcium or vitamin D intake
• Smoking
• Excessive intake of alcohol and caffeine
• Prolonged use of certain medications,
such as corticosteroids
• Underweight, low body fatness
Management
• Monitor Calcium and Vitamin

D intake and status
• A balanced diet of dairy,
fruits, and vegetables
• Avoid smoking
• Drink in moderation
• Exercise
• Medications/supplements
may be needed in certain
cases
Part 5:
Cancer
Cancer
Leading cause of death worldwide (≈10 million in 2020 =1 in 6 deaths)
Most common cancers: breast, lung, colon and rectum, prostate
≈⅓ of deaths are due to tobacco use, high BMI, alcohol consumption, low
fruit and vegetable intake, and lack of physical activity
Many cancers can be cured if detected early and treated effectively
Increased survival: Improvements in early detection & new anticancer therapies

(Khachfe;Rahal et al., 2020)
Carcinogenesis
• Cancer
• Uncontrolled growth and spread of abnormal cells
• Carcinogenesis
• Process by which normal, healthy cells transform into cancer cells
• The development of a malignant tumor in otherwise healthy tissue
is the result of a complex series of events beginning with a
single cell that has acquired malignant properties through cellular
DNA damage
Carcinogenesis
• Transformation of the cell produced by
interaction of chemicals, radiation or viruses
Initiation with DNA ➔ occurs rapidly
• Cell remains dormant for a variable period
• Initiated cells multiply ➔ neoplasm

Promotion established
• Tumor cells aggregate and grow ➔ malignant

tumor with capacity for tissue invasion
Progression
• Metastasis ➔ spreading to distant tissues
and organs
Risk Factors
• Genetics
• Obesity/increased body fat
• Sedentary lifestyle
• Inadequate fruit and vegetable intake
• Excessive alcohol intake
• Excessive intake of red and cured meat
• Smoking or tobacco use, passive exposure to tobacco
• Viruses
• Occupational/ environmental exposure to carcinogens
• Radiation exposure
• Repetitive tissue injury (e.g. chronic reflux)
• …
Nutrition, PA & Cancer Etiology
Nutrition
• May modify the carcinogenic process at any stage
• Diet contains enhancers and inhibitors of cancer
Obesity
• Increases the risk of cancer and its recurrence
• Excess body weight ➔ increased estrogens, androgens, insulin, insulin-like growth factors ➔ cell and tumor growth
Alcohol
• Increased risk for certain cancers, especially with concurrent tobacco use
• Negatively affects the health of cancer survivors
Fat
• Processed foods high in fat and red meat is associated with cancer
• Eating more omega-3 fatty acids in relation to omega-6 fatty acids potentially reduces risk of cancer (benefit unclear)
Fruits and vegetables
• Anticarcinogenic agents (antioxidants such as vitamins C and E, selenium, and phytochemicals)
• Unlikely that any one substance is responsible for benefit
Physical activity
• Moderate to vigorous activity reduces cancer risk
• Physical activity strengthens the immune system, regulates sex hormones, insulin, and prostaglandins and helps in the
maintenance of a healthy weight
Preservation & cooking
methods enhancing carcinogenesis
 N-nitrosocompounds (NOC) known as nitrosamines:
◦ Formed in smoked, salted, and pickled foods cured
with nitrates and nitrites
◦ Give hot dogs and luncheon meats their pink color
◦ Also found in vegetables and drinking water
 Acrylamide
◦ Byproduct formed during frying, roasting and baking
at very high temperatures
◦ Potentially carcinogenic
 Polycyclic aromatic hydrocarbons (PAHs)
◦ Form on the surface of meat when grilling at high
temperatures
Prevention Guidelines
Activity
• Salim is a 55-year-old male recently diagnosed with diabetes
1) Which questions would you like to ask him to assess his

nutritional status?
2) Discuss 3 nutrition and lifestyle messages you would like to

share with him
Activity
Salma, a 75 year old female is known to have hypertension.
She has been recently diagnosed with breast cancer, for which
she took chemotherapy and radiotherapy. She is currently in
remission and is presenting to you for nutritional counseling.
1) What would you like to ask her?
2) What would you advise her to do?

References
Carey, R. M., Whelton, P. K., & Committee*, A. A. H. G. W. (2018). Prevention, detection,
evaluation, and management of high blood pressure in adults: synopsis of the 2017 American
College of Cardiology/American Heart Association Hypertension Guideline. Annals of internal
medicine, 168(5), 351-358.
International Diabetes Federation. (2018). IDF MENA Members. Retrieved from https://idf.org/our-
network/regions-members/middle-east-and-north-africa/members/39-lebanon.html
Khachfe, H. H., Rahal, Z., Sammouri, J., Kheil, M., Baydoun, H., Chatila, D., . . . Fouad, F. M.
(2020). Cancer in Lebanon: a review of incidence rates from 2008 to 2015 and projections till
2025. South Asian Journal of Cancer, 9(03), 147-152.
Najem, R. N., Halawi, A., Tanios, B., Ambriss, R., Bikai, R. E., Partington, G., . . . Alfa, A. K. A.
(2021). May Measurement Month 2019: an analysis of blood pressure screening results from
Lebanon. European Heart Journal Supplements, 23(Supplement_B), B92-B94.
Smith, A. M., Collene, A., & Spees, C. (2018). Wardlaw's Contemporary Nutrition: A functional
Approach (5 ed.): McGraw Hill Education.
WHO. (2022). Cardiovascular diseases. Health topics Retrieved from https://www.who.int/health-
topics/cardiovascular-diseases#tab=tab_1

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NUT201: Fundamentals of Human Nutrition

• Chronic disease characterized by

International Diabetes Federation, 2022

 Adrenaline: secreted in times of anger or fear; it signals the breakdown of liver

• Leading cause of mortality worldwide

Injury / Damage in the lining of arteries

Narrowing of arteries: Atherosclerosis

(Najem;Halawi et al., 2021; Carey;Whelton et al., 2018)

If untreated, chronic high blood pressure may lead to:

• Emphasizes intake of vegetables, fruits, and whole

 Loss of the ability to produce enough of

 Many people with lactose intolerance can consume moderate

 Lactose is better digested when combined with other foods as

 Hard cheeses and yogurt are more tolerated

 It is important to include calcium-rich

– Peak bone mass is the highest

• Monitor Calcium and Vitamin

Leading cause of death worldwide (≈10 million in 2020 =1 in 6 deaths)

Most common cancers: breast, lung, colon and rectum, prostate

Many cancers can be cured if detected early and treated effectively

Increased survival: Improvements in early detection & new anticancer therapies

• Initiated cells multiply ➔ neoplasm

• Tumor cells aggregate and grow ➔ malignant

• Salim is a 55-year-old male recently diagnosed with diabetes

1) Which questions would you like to ask him to assess his

2) Discuss 3 nutrition and lifestyle messages you would like to

1) What would you like to ask her?

2) What would you advise her to do?

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