Supplements

Oxford EducatorPowerPoint slides: organised by chapter and will include tables, images, figures, and diagrams from the text.

Instructor’s Resource Manual• 60 Tutorial Activities: task-orientated activities related to the week’s topic. • 60 Discussion Questions: relate to the week’s topic and will encourage group debate. • Further reading/resources

TestbankA list of questions that lecturers can draw upon for assessment purposes. 30 questions per chapter, comprising of:

• 20 multiple-choice questions per chapter • 10 short answer questions per chapter

Image gallery• Access to the figures, diagrams and tables from the textbook.

Oxford Learner• Oxford Health Hub oup.com.au/ohh. The OHH is the online home to a wealth of resources

to help students throughout their health science or nursing degree. Here students will find a huge selection of activities, additional material, and interactive revision devices to help them get the most from their study.

• Weblinks and further reading lists that will expand a student’s understanding of particular topics or concepts

Linda Tapsell is a Professor of Nutrition within the School of Medicine, Faculty of Science, Medicine and Health at the University of Wollongong.

To purchase or request an inspection copy, visit oup.com.au/tapsell or oup.com.au/tapsellebook

Garlic has been used by humans for over 7000 years for both culinary and medicinal purposes. It has nutritional benefits; part can be used as an adhesive; it’s often blamed for bad breath; and, in mythology, is noxious to vampires.

An everyday plant that intersects throughout our lives in so many ways.

Food, Nutrition and Health takes a holistic approach to the study of the relationships between food, nutrition and health throughout the lifecycle. It canvases a full spectrum of relevant issues, while providing a clear framework for understanding and working with nutrition science—gradually building up a knowledge base and setting it in practice contexts.

Key concepts are introduced early then built upon in more detail, and it takes a fruitful pedagogical approach that develops knowledge, fosters research skills, and encourages critical thinking.

Edited by

FOOD, NUTRITION AND HEALTH

Print A$110.00 • NZ$145.00 • 9780195518344 | Ebook A$82.95 • NZ$108.99 • 9780195587982 | September 2013 • 405pp

contentsPART 1 AN INTRODUCTION TO NUTRITION1. Food and Health: A Biological Perspective

- How does food consumption affect health?

- How do we know that food intake affects health?

- How has the biological understanding of nutrition evolved and where is it headed?

2. Applying Nutrition Principles in the Lifecycle

- How can understanding the biological effects of food be applied to human health?

- How do we know if there is a problem with nutrition?

- How are nutrition problems in the community addressed?

3. Nutrition in a Social and Environmental Context: An Introduction

- Who are the main stakeholders in food and nutrition at a societal level?

- What is food and nutrition policy?

- How does nutrition practice and research relate to food policy?

PART 2 FOOD AND HEALTH: A BIOLOGICAL PERSPECTIVE4. Food: The Primary Source of Energy and Nutrients

- What happens to food when you eat it?

- What does energy balance mean?

- How does eating protein, fat or carbohydrate influence weight?

- Why do we need vitamins and minerals?

- How much of all the nutrients do we need?

5. Extending Knowledge on Food Components

- What are the different types of carbohydrate, fat and protein, and why is this important?

- What is dietary fibre?

- What can we say about other components in food?

- Why is water an important part of nutrition?

- What about alcohol?

6. Categorising Foods in Terms of Nutrient Content

- Which foods are the best for delivering carbohydrate, protein and fat?

- Which foods have the most vitamins and minerals?

- Which foods deliver the best nutritional value?

7. Categorising Foods in Terms of Healthy Diets: Cuisines, Dietary Patterns and Dietary Guidelines

- What is a cuisine?

- Which dietary patterns are associated with disease?

- What do dietary guidelines mean?

PART 3 APPLICATIONS OF NUTRITION THROUGHOUT THE HUMAN LIFECYCLE8. Nutrition During the Lifecycle: Pregnancy and Lactation

- What are the key nutrients required before and during pregnancy?

- What are the energy requirements of pregnancy?

- What are the best foods to eat during pregnancy?

- How does breastfeeding work?

- Why is breastfeeding best for mother and baby?

9. Nutrition During the Lifecycle: Infancy and Childhood

- Why is it necessary to introduce solid foods to infants in their first year of life?

- What are the most appropriate first foods for infants and when should they be introduced?

- How can healthy eating habits be established?

- What are the key nutritional issues for children?

- How can child obesity be prevented?

10. Nutrition During the Lifecycle: The Prevention of Chronic Disease in Adulthood

- What is the most important dietary factor in preventing chronic lifestyle-related disease?

- Which foods are best to include in the diet to prevent chronic disease in adulthood?

- Where do all the other foods, beverages and alcohol fit in the dietary pattern?

- What is the role of physical activity and general well-being in this scenario?

11. Nutrition during the Lifecycle: Nutrition Needs of Older Adults

- What are the categories of ageing?

- What are some of the common nutrition-related health problems seen in old age?

- Which nutrients are required in higher amounts in old age?

- Why does malnutrition emerge as a problem in old age?

- What are the particular considerations for older people living in institutional settings?

12. Nutrition Tools: Dietary Assessment, Food Databases and Dietary Modelling

- What is dietary assessment?

- How is dietary assessment conducted at the population level?

- What is the role of food and nutrient databases?

- What is dietary modelling?

PART 4 FOOD AND NUTRITION POLICY AND PRACTICE13. Food and Nutrition Policy and Frameworks

- What is a food and nutrition system and how does nutrition policy work?

- What is food security?

- What are food standards and laws?

- How does food innovation work?

14. Locations of Nutrition Practice

- How can individuals and communities get help with nutrition problems and advice?

- How do government agencies work in nutrition?

- What is the role of nutrition researchers?

- What role does the food industry play in nutrition?

15. Future Directions in Nutrition

- What are the main challenges facing nutrition today?

- What is needed in nutrition research?

- Where will nutrition practice go in the future?

- What will the food supply of the future look like?

Tour the Pedagogical Features

Each chapter begins with clearly

described and achievable objectives

that reflect the main content of the

chapter. You will see throughout the

text that these objectives build in

complexity as you build up blocks of

knowledge.

Building blocks set

the scene, by providing

snapshots of the learning

required to understand

and build knowledge

of the information

contained in the chapter.

In one sense the study of food,

nutrition and health is relatively

straightforward and tangible, but

at the same time it is complex and

multidimensional. Controversies

highlight the complex issues and

are easily located on part openers

throughout the book.

Dotted throughout the text

are Margin notes, drawn from

the Glossary and Key terms

to help identify and readily

check understanding of key

terms in use across the health

disciplines.

Chapter objectives

This chapter will enable the reader to:

• Broadly define food and the relationship between food consumption and health

• Describe the ways in which scientific research provides the evidence on effects of food on health

• Appreciate the relative contributions of different scientific disciplines in providing this evidence

• Briefly describe the history of nutrition science and identify emerging areas of knowledge

Key terms

FoodPhysiologyBiochemistryNutrientsNutritional balance

Building blocks

Understanding the relationship between food, nutrition and health first requires a ‘big picture’ of health and where food consumption fits in. One way of doing that is to start with a biological view of health. Even then there are many aspects to understanding how the human body operates and what happens when food is consumed. This introductory chapter provides the overall conceptual framework on how food influences health from a biological perspective, how we know this to be the case, and the directions for building this understanding in the future. Concepts raised here will be expanded on in future chapters.

Chapter overview

IntroductionHow does food consumption

affect health?How do we know that food

intake affects health?How has the biological

understanding of nutrition evolved and where is it headed?

Summary

Food and Health: A Biological Perspective

01Chapter

01_TAP_FNH1_18344_2pp.indd 4 5/7/13 2:39 PM

pt.

FOOD AND HEALTH: A BIOLOGICAL PERSPECTIVE

02

52

Key points• Energy balance occurs when the amount of energy consumed equals the amount of energy

expended.

• A negative energy balance usually results in weight loss and a positive energy balance in weight gain.

• While this appears a simple situation, there is increasing knowledge about the components of energy balance and how food intake and physical activity may influence the energy balance equation.

• Appreciating the energy value of food is important in managing energy balance, but even then, research suggests that there may be limitations to simply using the macronutrient composition to determine energy value to the human, particularly with unprocessed foods.

How does eating protein, fat or carbohydrate

influence weight?

Macronutrients are the primary source of energy in the diet, but they also have quite different roles within the body. Carbohydrate is the main fuel source of the body and dietary fat is easily stored as fat. The metabolism of protein has a greater energy cost. This has given rise to propositions that a diet with a greater proportion of one or the other, or of different types of a single macronutrient class, might be advantageous for weight loss. Given the principles of energy balance, an eating pattern that would result in lower energy intakes is actually the target.

Controversy 4.1

Which diet is best for weight loss?The assumptions behind different diet formulations are often based on mechanistic understandings of the energy value and/or of the satiating properties of macronutrients. Some of these formulations are adopted in diets with notable names, for example the Atkins diet is an example of a high-protein formulation. The best diet for weight loss is one that achieves a negative energy balance and this may vary for different people under different circumstances.

Low­fat diets

Fat has the greatest energy density (kilojoules per gram), so low-fat diets would be assumed to be lower in energy, and low-fat foods may be less energy-dense (contain fewer kilojoules per gram of food). However, energy density is not the only factor in managing weight loss [10], and low-fat foods are not necessarily low-energy foods.

High­protein diets

High-protein diets may appear to be more satiating and therefore could influence overall food intake, and the level of dietary protein may influence energy expenditure, but this is not necessarily the case in practice [11].

04_TAP_FNH1_18344_2pp.indd 52 08/05/13 11:12 PM

Chapter objectives

This chapter will enable the reader to:

• Broadly define food and the relationship between food consumption and health

• Describe the ways in which scientific research provides the evidence on effects of food on health

• Appreciate the relative contributions of different scientific disciplines in providing this evidence

• Briefly describe the history of nutrition science and identify emerging areas of knowledge

Key terms

FoodPhysiologyBiochemistryNutrientsNutritional balance

Building blocks

Understanding the relationship between food, nutrition and health first requires a ‘big picture’ of health and where food consumption fits in. One way of doing that is to start with a biological view of health. Even then there are many aspects to understanding how the human body operates and what happens when food is consumed. This introductory chapter provides the overall conceptual framework on how food influences health from a biological perspective, how we know this to be the case, and the directions for building this understanding in the future. Concepts raised here will be expanded on in future chapters.

Chapter overview

IntroductionHow does food consumption

affect health?How do we know that food

intake affects health?How has the biological

understanding of nutrition evolved and where is it headed?

Summary

Food and Health: A Biological Perspective

01Chapter

01_TAP_FNH1_18344_2pp.indd 4 5/7/13 2:39 PM

pt.

AN INTRODUCTION TO NUTRITION

01

18

Introduction

In the first chapter we asked, why do we need nutritionists? If we define nutritionists as people who apply knowledge of nutrition, we can see that this can occur at many different levels. If we can identify these levels we might also understand why nutrition advice often seems to vary. In many cases it has to do with the context in which the nutrition knowledge is being applied.

Like all areas of science, we use the knowledge of nutrition in many different ways. At the most basic level, we eat food because we know it is necessary for life. From there we may choose different foods because we have come to know they are better than others for our health. We might use the information on food labels in making those choices. If we are not sure we may look for advice, such as national dietary guidelines formulated by government health authorities [1]. If we become ill and this has implications for the food we eat, we may need to consult a health practitioner, and for specific nutrition expertise may consult a dietitian (www.daa.asn.au).

As a broader community, we will want to protect against the development of these illnesses in the population and ensure the food supply is supporting that. Governments will also be involved at this level, developing public health-related policies, guidelines and standards aimed at protecting the health of the population (www.foodstandards.gov.au; www.nhmrc.gov.au; www.eatforhealth.gov.au). The food and agricultural industries are also important in this scenario because they produce and deliver the food supply to the population at large (www.daff.gov.au; www.daff.gov.au/abares).

Knowledge helps to drive this scenario, and research contributes to the generation of new knowledge. Research plays a very important role in expanding the understanding of all aspects of nutrition, from the details of how food supports health, to how better to implement strategies that have an effect on health (www.arc.gov.au; www.nhmrc.gov.au). These different locations for practice have different knowledge needs to suit their applications, so nutrition practice in healthcare can take many forms.

How can understanding the biological effects of food

be applied to human health?

A consideration of life stages provides a useful platform for organising the application of nutrition knowledge to the healthcare of individuals and communities. Eating food is part of survival (recall that ‘you are what you eat’), so understanding the needs of the body throughout the stages of life provides some insight into determining which foods might be best to consume. Not surprisingly, the resource needs of the first stages of life are critical, with subsequent growth and development affected by how the nutritional stage is set. For example, pregnancy and lactation are changed physiological conditions with specific requirements for nutrition resources. With maturation of the adult person and possible declines in physical activity, body composition may change, as will body chemistry and function, altering the need for energy and nutrients. The onset of chronic disease and the loss of functionality demand particular consideration in terms of changes to eating habits.

Most people are healthy to begin with, so the focus is on meeting nutritional requirements and maintaining energy balance. In the absence of chronic disease, applying nutrition principles from the perspective of managing physiological changes and functionality is the primary concern. Details of how this is done are given in Chapters 8–11, with different emphases depending on the stage of life examined. Matching physiological changes and meeting specific nutrient requirements are key focal points for pregnancy and lactation [1]. Meeting requirements is also important for infants and

Dietary guidelinesstatements on strategies for choosing a healthy diet based on scientific evidence on the effects of food intake and dietary patterns on health.

Dietary guidelines provide recommendations for achieving a healthy diet; food standards regulate the composition of food and the statements that can be made about food products.

Life stagesdefined periods throughout the lifespan, such as infancy, childhood, adulthood, old age.

02_TAP_FNH1_18344_2pp.indd 18 5/7/13 3:07 PM

Chapter objectives

This chapter will enable the reader to:

• Appreciate the significance of life stages as a framework for applying nutrition knowledge to healthcare

• List key methods and standards that form the cornerstone of health-related practice in nutrition

• Describe locations of nutrition practice addressing health-related problems in the community

Key terms

Dietary guidelinesLife stageFood composition databasesNutrient reference values

Chapter overview

IntroductionHow can understanding the

biological effects of food be applied to human health?

How do we know if there is a problem with nutrition?

How are nutrition problems in the community addressed?

Summary

Applying Nutrition Principles in the Lifecycle

02Chapter

Building blocks

The basic biological concepts of nutrition help to understand how food affects health from a biochemical and physiological perspective. This can translate to practice along a number of different paths. In the first instance, though, considering nutritional needs from a life-stage perspective provides a useful way of setting the scene. In addition, methods for assessing dietary intakes, and the use of standards and guidelines evaluating dietary intake, are cornerstones for basic practices or applications in nutrition. Where the application relates to the health of individuals, a number of practice domains can be seen. In a broader societal view, this could also take in health policy, industry applications and nutrition research. This chapter introduces the frameworks of nutrition in the lifecycle and basic practices at the healthcare level.

02_TAP_FNH1_18344_2pp.indd 17 5/7/13 3:07 PM

Case studies throughout

the book reflect its focus on

health, food, nutrients and

nutrition. They showcase

the research and assist

students to reflect upon

the latest advances in

detection of nutritional

deficiency, maintenance

of health, prevention and

management of lifestyle-

related disease.

Food and nutrition facts

combine scientifically-

based facts about nutrients

with public health, and

heals promotion initiatives

with pathways for practice.

These are presented within

the context of building

on the development of

speciality and expertise,

starting with individual

self-care and working

through various levels of

professional competency.

Information from new

research is ever present,

constantly underpinning

the knowledge base of the

discipline. Research in practice sections link the

latest research to current

practice models.

Review and reflect sections include details about issues and facts related to

nutrition, public health and health services, and include questions to encourage

reflection about application to practice.

pt.

AN INTRODUCTION TO NUTRITION

01

20

Key tools of nutrition practice include dietary assessment methods, databases of food composition,  population nutrient reference values, and food and dietary policies and guidelines. These tools are explained in detail in Chapter 12.

For the practitioner, dietary assessment methods are necessary to be able to gauge the extent of the nutritional problem. There are many forms of dietary assessment, ranging from surveys (questionnaires), to food records and observations of eating behaviour. The best method for assessing intake will very much depend on the purposes of the practice, the information required and the resources to undertake the assessment. Decisions on methods of choice also need a well-informed nutrition base.

Food composition databases are required to convert information on food to that of nutrients. It is this process that tells us, for example, that a diet with many takeaway foods has a certain level of fat. From this information judgments can be made and appropriate advice given or action taken. The development of food composition databases is another significant area of nutrition science, and naturally it also carries considerations for limitations of use and application.

Population nutrient reference values provide the values for nutrient intakes that would best support the health of most people in the population. As such they enable practitioners to compare values with those reported in their dietary assessment. Because there is a great deal of science behind the derivation of these values, it is important to be able to apply this knowledge appropriately.

The Australian Dietary Guidelines, Food Standards [13] and other areas related to nutrition policy are all readily accessible for nutrition practice, but, as with the tools described above, their use also needs to be applied in the context of broader nutrition knowledge (see Chapter 12).

Food composition databaseslists of foods and their nutrient composition.

Nutrient reference valuesamounts of nutrients that are recommended for consumption for groups and individuals in a population.

A starting point in nutrition practice is the ability to assess dietary intake using valid methods and to make judgments on the quality of the diet with reference to dietary guidelines and food standards.

Case Study 2.1

IodineAustralia has been classified as mildly iodine-deficient by the World Health Organization. Numerous studies have shown that children and pregnant and breastfeeding women are most at risk [4–9]. Meta-analyses indicate that moderate to severe iodine deficiency without supplementation may result in a population-level loss of intelligence in children of around 10–13.5 IQ points [10, 11].

The internationally recognised standard for assessing iodine adequacy in populations is to assess median urinary iodine concentrations (MUIC) of groups by taking spot (casual) urine samples. Over 90% of iodine intake is excreted in the urine, so urinary excretion values provide a good proxy for dietary intake. To compare populations, and because of the relative ease of obtaining samples in children at school, it is recommended that MUIC be assessed in schoolchildren aged 6–12 every five years [12].

The WHO endorses universal salt iodisation (USI) whereby all salt for human and animal consumption is iodised. Salt has continued to be the most common food vehicle for iodine fortification because salt fulfils the following criteria: salt is eaten in consistent amounts by a large proportion of the target population; iodine from iodised salt is well absorbed; iodised salt does not affect the sensory properties of food; salt production is usually limited to a few producers; and the cost of iodisation of salt is very low and the technology relatively simple. But since salt consumption is also linked to hypertension care needs to be taken in how salt is used as a delivery agent for iodine.

02_TAP_FNH1_18344_2pp.indd 20 5/7/13 3:07 PM

pt.

AN INTRODUCTION TO NUTRITION

01

20

Key tools of nutrition practice include dietary assessment methods, databases of food composition,  population nutrient reference values, and food and dietary policies and guidelines. These tools are explained in detail in Chapter 12.

For the practitioner, dietary assessment methods are necessary to be able to gauge the extent of the nutritional problem. There are many forms of dietary assessment, ranging from surveys (questionnaires), to food records and observations of eating behaviour. The best method for assessing intake will very much depend on the purposes of the practice, the information required and the resources to undertake the assessment. Decisions on methods of choice also need a well-informed nutrition base.

Food composition databases are required to convert information on food to that of nutrients. It is this process that tells us, for example, that a diet with many takeaway foods has a certain level of fat. From this information judgments can be made and appropriate advice given or action taken. The development of food composition databases is another significant area of nutrition science, and naturally it also carries considerations for limitations of use and application.

Population nutrient reference values provide the values for nutrient intakes that would best support the health of most people in the population. As such they enable practitioners to compare values with those reported in their dietary assessment. Because there is a great deal of science behind the derivation of these values, it is important to be able to apply this knowledge appropriately.

The Australian Dietary Guidelines, Food Standards [13] and other areas related to nutrition policy are all readily accessible for nutrition practice, but, as with the tools described above, their use also needs to be applied in the context of broader nutrition knowledge (see Chapter 12).

Food composition databaseslists of foods and their nutrient composition.

Nutrient reference valuesamounts of nutrients that are recommended for consumption for groups and individuals in a population.

A starting point in nutrition practice is the ability to assess dietary intake using valid methods and to make judgments on the quality of the diet with reference to dietary guidelines and food standards.

Case Study 2.1

IodineAustralia has been classified as mildly iodine-deficient by the World Health Organization. Numerous studies have shown that children and pregnant and breastfeeding women are most at risk [4–9]. Meta-analyses indicate that moderate to severe iodine deficiency without supplementation may result in a population-level loss of intelligence in children of around 10–13.5 IQ points [10, 11].

The internationally recognised standard for assessing iodine adequacy in populations is to assess median urinary iodine concentrations (MUIC) of groups by taking spot (casual) urine samples. Over 90% of iodine intake is excreted in the urine, so urinary excretion values provide a good proxy for dietary intake. To compare populations, and because of the relative ease of obtaining samples in children at school, it is recommended that MUIC be assessed in schoolchildren aged 6–12 every five years [12].

The WHO endorses universal salt iodisation (USI) whereby all salt for human and animal consumption is iodised. Salt has continued to be the most common food vehicle for iodine fortification because salt fulfils the following criteria: salt is eaten in consistent amounts by a large proportion of the target population; iodine from iodised salt is well absorbed; iodised salt does not affect the sensory properties of food; salt production is usually limited to a few producers; and the cost of iodisation of salt is very low and the technology relatively simple. But since salt consumption is also linked to hypertension care needs to be taken in how salt is used as a delivery agent for iodine.

02_TAP_FNH1_18344_2pp.indd 20 5/7/13 3:07 PM

pt.

AN INTRODUCTION TO NUTRITION

01

22

These services may work across all age groups, including maternal, child, home and aged care facilities. The goal of nutrition in supporting health is the same throughout, but the particular knowledge and applications will depend on the needs and circumstances of the specific group.

Primary healthcare services provide medical, nursing and allied health support for individuals in the community and associated groups. The nutrition knowledge applied in these circumstances will also depend on circumstances, but in the first instance will reference the dietary guidelines as they relate to specific groups. For specific problems, such as the need to address the risk of cardiovascular disease, resources from related authoritative groups such as the Heart Foundation may provide more specific information. Where individualised advice is required, a consultation with a dietitian may be required. It all comes down to the level of translation required, which draws on the degree of specialised training in nutrition undertaken by the healthcare professional.

At the community and institutional level, food service systems play a major role in the decisions on food choice. These include services such as Meals on Wheels [17] and foodservice systems in childcare centres, nursing homes, hospitals and worksite canteens. The nutrition knowledge applied in foodservice systems includes and goes beyond the dietary guidelines. This references a range of standards and policies that have been developed through the fundamentals of nutrition science to ensure that the food delivered to recipients meets nutritional requirements, is safe to eat and is likely to be consumed. This includes policy relating to recommended dietary intakes of nutrients for different age groups, food safety standards and knowledge of culinary preferences and needs of the recipients. Most, if not all, people working in this area would benefit from an understanding of the fundamental principles of nutrition and food safety. At higher levels of responsibility, as in the case of a foodservice dietitian [18], they would also need to apply standards for determining and monitoring food and nutrition quality, while translating and integrating a number of areas of nutrition knowledge.

Food and nutrition facts

Meals on Wheels: More than just a mealThe concept of Meals on Wheels, delivering meals to frail elderly people who wish to remain in their own homes and maintain a degree of independence, but who require a little extra help, began in Britain during the Second World War. The service came to Australia in 1952; it was started in Melbourne by an individual, taken over by the Red Cross and then spread to other states. Over 14.8 million meals are delivered each year to approximately 53 000 Australians in need by a band of around 78 000 volunteers.The work carried out by the service also includes food safety and labelling for Meals on Wheels, research and resource development, advocacy in regard to national policy issues, and membership support [17, 19].

When disease takes hold and food intake can influence outcomes, the degree of knowledge integration, translation and application is much more demanding. It requires an understanding of where and how the condition deviates from the normal (pathophysiology) and how the components of food may influence this process. Combining this with an understanding of a person’s usual eating

02_TAP_FNH1_18344_2pp.indd 22 5/7/13 3:07 PM

ch.

Nutrition in a Social and Environmental

Context

03

31

in food manufacturing includes the development of new products and this draws on research and development. This may relate to improving nutritional quality or establishing evidence of likely nutritional effects from consumption of those products. Nutrition research and marketing are important forms of nutrition practice with this stakeholder group (see e.g. <www.simplot.com.au, www.sanitarium.com.au, www.uncletobys.com.au>, <www.kelloggs.com.au>).

Retail and other food outletsIn large urbanised societies, retail outlets such as supermarkets provide the main interface between consumers and food. They provide all forms of food, and represent a significant component of the food value chain from the paddock to the plate. Other food outlets such as restaurants, cafés, fast food chains, institutional foodservice/catering systems and vending machines are also significant contributors to the food supply. These constitute key elements of exposure to the food environment in which individuals make food choices that ultimately influence their health.

Food value chain the added value that occurs in relation to events that begin with agriculture or primary food production through to food processing, manufacturing, distribution, retail, and foodservice to consumers.

What is food and nutrition policy?

Often when a problem is noted, for example the rising incidence of obesity, there is a call for something to be done about it. In the broadest sense this is where policy comes in. Food and nutrition policy concerns plans for actions to be taken to deal with nutrition problems. Knowledge of nutrition is fundamental to ensure these policies are grounded in sound science and strong evidence. Nutrition research is also an important underpinning factor in the development of policies and their related actions. There are a number of levels on which food and nutrition policy can be seen to operate. Food and nutrition policy is addressed in detail in the Chapters 13 and 14.

In reality, nutrition policy and related activity involves a principled approach; it concerns many sectors of government and the community at large and requires agencies for implementation and standards that inform this implementation. For example, food standards are set to protect public health. They govern the types of ingredients that can go into foods and the information that can be provided on labels. Food Standards Australia New Zealand (FSANZ) [5] develops the standards and they are enforced at state government level. Read more about these frameworks in Chapters 13 and 14.

Food policyPrinciples of action relating to the way food is dealt with by organisations and individuals.

Research in practice

B. Kelly, V. Flood & H. Yeatman (2011). Measuring local food environments: An overview of available methods and measures. Health & Place 17: 1284–93.

All forms of food outlets form part of the environmental exposure to food of varying types and quantities. Researchers have now developed ways of mapping the presence of these outlets as a starting point for examining how the environmental exposure to food might be addressed to improve health. In a review of studies it was found that methods for measuring local food environments included recording the number, type and location of food outlets as well as other factors, such as available food and beverage products, price, quality, and the presence of promotions or information. Research of this type informs areas of community nutrition practice and can be incorporated into the development of food policy and guidelines.

03_TAP_FNH1_18344_2pp.indd 31 5/7/13 2:24 PM

pt.

AN INTRODUCTION TO NUTRITION

01

28

Non-government organisationsThere are many community organisations that have an interest in nutrition. Examples in Australia include the Heart Foundation (www.heartfoundation.org.au) and the Cancer Council (www.cancercouncil.com.au). Groups such as these take a particular interest in how nutrition relates to their specific concerns, such as the links between nutrition and the prevalence of heart disease and cancer, and how community education may assist in prevention. More general consumer advocacy groups (see e.g. <www.choice.com.au>) may address concerns supporting the general role of citizens in decisions that affect food and nutrition for the population.

Government departments and agenciesGovernment departments and agencies have many roles that have implications for food and nutrition (see Table 13.1). They need to protect public health, build an educated community, foster the creation of employment, encourage innovation and manage the economy. Food is associated with all these components. The development of a national food and nutrition policy can be seen as one step towards integrating the functions of government to improve the nutritional health of the population.

Case Study 3.1

Food and Health DialogueIn 2009 a Food and Health Dialogue was announced by the Australian Government (through the Department of Health and Ageing). It was a ‘joint government-industry-public health initiative aimed at addressing poor dietary habits and making healthier food choices easier and more accessible for all Australians’.

A website of its activities is available to the public and includes information on activities and reports that deal with the question of how different stakeholder groups can work together to provide healthier food options. The position of nutrition science remains central to this activity as it provides the basis for strategies aimed at achieving the targeted health outcomes.

<www.foodhealthdialogue.gov.au/internet/foodandhealth/publishing.nsf/Content/about-us>

Review and reflect

Australia’s Health 2012 [1] reports:

1. There were 737 400 workers in health services industries in 2010 and in the period 2005–10 employment grew faster in that sector (23%) than in total employment (12%).

2. The number of workers in health occupations also grew in that period, increasing by 26% compared to 12% for all occupations.

What are some of the roles of health workers and how could they all be involved in promoting health by applying nutritional principles to practice?

03_TAP_FNH1_18344_2pp.indd 28 5/7/13 2:24 PM

Further encouragement

towards critical

reflection is provided

through Try it yourself sections.

Clearly drawn tables and figures illustrate

important details and

then invite analysis and

consideration towards

the meanings that

can be drawn from the

information presented.

Key points enable quick

revision of the some of

the main topics covered

throughout the chapter.

ch.

Nutrition in a Social and Environmental

Context

03

27

Introduction

Food is the main agent of nutrition because it delivers essential components that sustain health. The  position of food in society, however, is complex. We tend to eat food in a social and cultural context, so we may not always recognise the connections between nutrition science and food on the table. The culinary arts add a further dimension to this setting, and culinary practices may make little if any reference to nutritional concepts. Finally, in Western urbanised societies, food production, manufacturing and distribution is managed within a sophisticated industrial and trade-oriented system, where economics is a critical factor. Nevertheless, given the connection between food and health, knowledge of nutrition remains important, and there is a role for nutrition practice in all these domains. This chapter introduces the wider context in which nutrition science operates, to set the scene for more detailed discussion later (see Chapter 13).

Who are the main stakeholders in food

and nutrition at a societal level?

Food is dealt with by society in a number of ways, so there are stakeholders at many vantage points. Some stakeholders have a major influence on food choice behaviour. Others are important to the food value or supply chain. The food value chain is a concept that deals with the way food makes its way from where it is grown to where it is eaten (sometimes referred to as ‘paddock to plate’). Because there are so many dimensions to food in society, linking food policy with nutrition would require a working relationship across a number of sectors. This has implications for nutrition practice, because it means the knowledge of nutrition has to be effectively applied in several settings.

Stakeholderspeople or groups with a vested interest in an area under consideration.

Try it yourself

Look at a food product you have recently purchased from a supermarket. Using the information on the packet, identify as many groups as possible that may be related to the production of this food and the reasons behind your purchasing it.

Health servicesHealth services are clearly a major stakeholder group in nutrition practice. This is because nutrition is important in the prevention of chronic disease (such as obesity, type 2 diabetes and cardiovascular disease), dietary change is required in managing disease once it is established (such as for weight loss, supporting cholesterol-lowering and hypertension management), and dietary intervention is required for certain disease conditions; for example, malnutrition is a particular condition that has emerged in the elderly hospitalised population. As outlined in the previous chapter, health services provide a key location for various forms of nutrition practice.

03_TAP_FNH1_18344_2pp.indd 27 5/7/13 2:24 PM

pt.

FOOD AND HEALTH: A BIOLOGICAL PERSPECTIVE

02

148

Consider and discuss1. How do we know that dietary fat is associated with heart disease?2. What are the likely main sources of saturated fat and sodium in the Australian diet?3. How would consumers know how to improve the quality of their diet?4. What should be the main foods consumed to protect health?

Chronic lifestyle-related diseases are associated with lifestyle choices, and at the core of this is the type of food regularly consumed and the level of physical activity. These diseases develop over a long time and require long-term management. Since the effects of food on health are generated over long periods, it is not surprising that chronic disease sets in if diet quality over a lifetime is poor. The breakdown in physical health is systemic, affecting the fundamental processes of fuel supply through the vascular system, the uptake of glucose for energy and the breakdown of various control systems. The process is complex, and understanding the detail requires a broad knowledge of physiology, pathophysiology and biochemistry. For example, we now know that body fat is not inert but rather actively serves in a cascade of events that can lead to serious disease in a manner linked to basal inflammatory processes [29] (Figure 7.2). The functions of the gastrointestinal tract may be central to this problem [30].

Brain

Stromal cellBlood vessel

Adipocyte Macrophages

Obesity

Premature death

Immune function

Immunesystem

CancerType 2diabetes

Insulinresistance

Cardio-vasculardisease

T cells

Adipose organ

INFLAMMATION

Source: D. Dixit (2008). Adipose-immune interactions during obesity and caloric restriction: Reciprocal mechanisms regulating immunity and health span.

Journal of Leukocyte Biology 84(4): 882–92.

Figure 7.2

Adipose-immune interactions during obesity

07_TAP_FNH1_18344_2pp.indd 148 09/05/13 12:59 PM

pt.

FOOD AND HEALTH: A BIOLOGICAL PERSPECTIVE

02

42

Consider and discussWhy do some people call certain foods carbohydrates or carbs and others proteins? Are these terms useful? Is this the correct use of the word?Which foods would be difficult to term ‘carbs’ or ‘proteins’ in a colloquial sense?

CarbohydrateThe carbohydrate component of food is a major source of energy. It is gradually broken down into simple sugars enabling absorption, and these are transported to the liver and converted to glucose. Glucose elicits an insulin response and this hormone regulates the glucose passage into the cell. Once in the cell, glucose is metabolised to carbon dioxide and water to produce energy.

Nutrient components of wholemeal bread Amount per 100 g*

Protein 9 g

Fat 2.9 g

Dietary fibre 6.3 g

Carbohydrates 39.7 g

Niacin (vitamin B3) 3.18 mg

Biotin (vitamin B7) 7.8 μg

Folic acid 118 μg

Iodine 48 μg

Potassium 183 mg

Zinc 1.06 mg

*Values shown are taken from the NUTTAB 2010 food composition database

Table 4.1.

Nutrient composition of wholemeal bread

Figure 4.1

The two principle pathways of carbohydrate digestion and absorption

Small bowelLactose/sugar alcohols

Short-chain oligosaccharidesResistant starch

Non-starch polysaccharidesMonosaccharides

DisaccharidesMaltoseDextrins

GlucoseFructoseGalactose

Pancreatic enzymes

Bacterial enzymes

Brush border enzymes

Absorption

Absorption

Large bowel

Insulin secretion

Energy

Acetate Liver AcetatePropionate

Colonicepithelium

AcetatePropionate

Butyrate

CO2 and H2O

Liver, muscle, brain, kidney, RBC

04_TAP_FNH1_18344_2pp.indd 42 08/05/13 11:12 PM

pt.

AN INTRODUCTION TO NUTRITION

01

34

Review and reflect

The Australian Institute of Health and Welfare (AIHW) produces a regular report on Australia’s food and nutrition [4]. It describes the food and nutrition system and addresses the effects of food choice on personal health and the environment. The 2012 version provided the following key points:

Australia produces enough food to feed 60 million people.More than 9 in 10 people aged 16 and over do not consume enough serves of vegetables.One in 4 children has an unhealthy body weight and 6 in 10 adults are overweight or obese.Aboriginal and Torres Strait Islander people, rural and remote Australians and socio-economically

disadvantaged people are more at risk of diet-related chronic disease than other Australians.Why are these issues important, how could they be addressed through group actions, and what

are the implications for nutrition scientists and practitioners?

Figure 3.2

Key sectors in the community related to food and nutrition

NutritionalHealth ofPopulation

Health services to thecommunity

Public Health agency (e.g. government)

Nutrition research Food Industry

Key points• There are many stakeholder groups in food and nutrition.

• Nutrition researchers and practitioners can be associated with all stakeholder groups in sharing nutrition knowledge and engaging in nutrition research.

• The actions of stakeholders and their interaction with each other can all have a major impact on the application of nutrition with implications for the health of the population.

03_TAP_FNH1_18344_2pp.indd 34 5/7/13 2:24 PM

At the end of each chapter the

Summary pulls together key

points to help consolidate

knowledge and understanding

and provides an excellent

starting point for revision.

Each chapter ends with several

more challenging questions

For further discussion, to assist

with exam preparation.

In addition, Further reading

points the way to extending

knowledge and improving

learning.

In addition to the learning tools that the printed book

contains, the Oxford Health Hub is the online home to

a wealth of resources to help students throughout their

health science or nursing degrees. Here students will find

a huge selection of activities, additional material, and

interactive revision devices to help them get the most

from their study. Open to both students and lecturers,

the OHH aids both teaching and learning with accessible,

high quality digital supplements. Visit oup.com.au/ohh.

ch.

Applying Nutrition Principles in the

Lifecycle

02

23

habits and a knowledge of food composition then enables a specific dietary prescription to be drawn up that would help support the condition. The information provided in each case is usually different and therefore the application of generalised tools such as the dietary guidelines is inappropriate. The extent of nutrition knowledge required for this category of care is quite substantial, drawing on the basic sciences through to the evidence frameworks for the effects of diet on health. Medicare payments for dietetic services and employment of dietitians in hospitals reflect this required level of expertise.

Summary• The stages of life provide a useful framework for applying knowledge of the biological aspects of nutrition to health-related practice.

• Different emphases on nutritional aspects will be given for different stages of life.

• Managing nutrition problems throughout the life stages requires assessment tools and the use of standards for evaluating measurements.

• The applications of nutrition science in practice can occur at a number of levels, from individualised self-care through to managing individuals in healthcare institutions.

• The level of knowledge and demands for practice at these levels will vary as the complexity of the problem and levels of responsibility increase.

For further discussion

1. What are the main stages in life from a nutrition and health perspective?2. Why do life stages provide a useful framework for defining nutritional needs?3. How might requirements be determined using this framework?4. Why it is important to have good data on what people are eating?5. What are some of the methods used to identify nutrition problems in the community?6. How do we know if there are nutrition problems in the community?7. What are some of the nutrition-related problems likely to be seen in the community?8. How do governments and community groups work to provide nutritional support for people in

the community?

Further reading

Booth, M.L. & Samdal. O. (1997). Health-promoting schools in Australia: Models and measurement. Australian and New Zealand Journal of Public Health 21(4): 365–70.

Brown, W., Bryson, L., Byles, J., Dobson, A., Manderson, L., Schofield, M. et al. (1996). Women’s Health Australia: Establishment of the Australian Longitudinal Study on Women's Health. Journal of Women’s Health 5(5).

02_TAP_FNH1_18344_2pp.indd 23 5/7/13 3:07 PM

ch.

Applying Nutrition Principles in the

Lifecycle

02

23

habits and a knowledge of food composition then enables a specific dietary prescription to be drawn up that would help support the condition. The information provided in each case is usually different and therefore the application of generalised tools such as the dietary guidelines is inappropriate. The extent of nutrition knowledge required for this category of care is quite substantial, drawing on the basic sciences through to the evidence frameworks for the effects of diet on health. Medicare payments for dietetic services and employment of dietitians in hospitals reflect this required level of expertise.

Summary• The stages of life provide a useful framework for applying knowledge of the biological aspects of nutrition to health-related practice.

• Different emphases on nutritional aspects will be given for different stages of life.

• Managing nutrition problems throughout the life stages requires assessment tools and the use of standards for evaluating measurements.

• The applications of nutrition science in practice can occur at a number of levels, from individualised self-care through to managing individuals in healthcare institutions.

• The level of knowledge and demands for practice at these levels will vary as the complexity of the problem and levels of responsibility increase.

For further discussion

1. What are the main stages in life from a nutrition and health perspective?2. Why do life stages provide a useful framework for defining nutritional needs?3. How might requirements be determined using this framework?4. Why it is important to have good data on what people are eating?5. What are some of the methods used to identify nutrition problems in the community?6. How do we know if there are nutrition problems in the community?7. What are some of the nutrition-related problems likely to be seen in the community?8. How do governments and community groups work to provide nutritional support for people in

the community?

Further reading

Booth, M.L. & Samdal. O. (1997). Health-promoting schools in Australia: Models and measurement. Australian and New Zealand Journal of Public Health 21(4): 365–70.

Brown, W., Bryson, L., Byles, J., Dobson, A., Manderson, L., Schofield, M. et al. (1996). Women’s Health Australia: Establishment of the Australian Longitudinal Study on Women's Health. Journal of Women’s Health 5(5).

02_TAP_FNH1_18344_2pp.indd 23 5/7/13 3:07 PM

ch.

Applying Nutrition Principles in the

Lifecycle

02

23

habits and a knowledge of food composition then enables a specific dietary prescription to be drawn up that would help support the condition. The information provided in each case is usually different and therefore the application of generalised tools such as the dietary guidelines is inappropriate. The extent of nutrition knowledge required for this category of care is quite substantial, drawing on the basic sciences through to the evidence frameworks for the effects of diet on health. Medicare payments for dietetic services and employment of dietitians in hospitals reflect this required level of expertise.

Summary• The stages of life provide a useful framework for applying knowledge of the biological aspects of nutrition to health-related practice.

• Different emphases on nutritional aspects will be given for different stages of life.

• Managing nutrition problems throughout the life stages requires assessment tools and the use of standards for evaluating measurements.

• The applications of nutrition science in practice can occur at a number of levels, from individualised self-care through to managing individuals in healthcare institutions.

• The level of knowledge and demands for practice at these levels will vary as the complexity of the problem and levels of responsibility increase.

For further discussion

1. What are the main stages in life from a nutrition and health perspective?2. Why do life stages provide a useful framework for defining nutritional needs?3. How might requirements be determined using this framework?4. Why it is important to have good data on what people are eating?5. What are some of the methods used to identify nutrition problems in the community?6. How do we know if there are nutrition problems in the community?7. What are some of the nutrition-related problems likely to be seen in the community?8. How do governments and community groups work to provide nutritional support for people in

the community?

Further reading

Booth, M.L. & Samdal. O. (1997). Health-promoting schools in Australia: Models and measurement. Australian and New Zealand Journal of Public Health 21(4): 365–70.

Brown, W., Bryson, L., Byles, J., Dobson, A., Manderson, L., Schofield, M. et al. (1996). Women’s Health Australia: Establishment of the Australian Longitudinal Study on Women's Health. Journal of Women’s Health 5(5).

02_TAP_FNH1_18344_2pp.indd 23 5/7/13 3:07 PM

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