Introduction to Human Nutrition

352 Introduction to Human Nutrition

appropriate chapters and sections of this series of
textbooks.

The role of nutrition

The evidence that diets and specifi c nutrient defi cien-
cies and excesses infl uence the development of NCDs
and may therefore be used in prevention and treatment
is solid. It comes from extensive research which collec-
tively gave convincing evidence of the relationships
between nutrition and NCDs: fi rst, from ecological
studies which compared different populations, the
effects of migration of populations, food availability
during economic development, and differences in
dietary and nutrient intakes. Second, numerous epide-
miological studies have established the associations
between diet and biological risk factors of NCDs. Third,
interventions with specifi c nutrients and foods in
placebo-controlled trials using both healthy and dis-
eased subjects confi rmed the relationships seen in epi-
demiological studies. And last, molecular and genetic
research has elucidated many mechanisms through
which diet and nutrients affect genetic mutation and
expression, adding to our knowledge of how nutrition
infl uences NCD development. This body of knowledge
has led to several sets of international dietary recom-
mendations and guidelines to reduce the burden of
nutrition-related NCDs. An example of one such set of
guidelines from the World Health Organization (WHO)
is shown in Box 15.1. These generic recommendations
could be used as the basis for the development of
country-specifi c strategies and food-based guidelines
for dietary prevention of NCDs.

Table 15.1 Risk factors for nutition-related noncommunicable diseases (NCDS)

Societal Behavioral Biological NCDs

Socioeconomic status

Cultural habits

Environmental factors

Smoking

Alcohol abuse

Lack of physical activity

Inappropriate diets:

inadequate

fi ber

micronutrients

excess

total fat

saturated fat

trans fat

cholesterol

salt (NaCl)

energy

Tobacco addiction

Alcohol addiction

Dyslipidemia

Hyperlipidemia

Insulin resistance

Hypertension

Obesity (body composition)

Lung disease

Cardiovascular disease

Atherosclerosis

Cerebrovascular disease

Stroke

Ischemic heart disease

Myocardial infarction

Diabetes

Osteoporosis

Dental caries

Cirrhosis

Diet-induced cancers

Box 15.1 The WHO population nutrient intake goals for

prevention of death and disability from NCDsa

Dietary factor Recommended goal

(food or nutrient) (range)

Total fat 15 –30% of total energy

Saturated fatty acids <10% of total energy

Polyunsaturated fatty acids (PUFAs) 6–10% of total energy

n-6 PUFAs 5–8% of total energy

n-3 PUFAs 1–2% of total energy

Trans fatty acids <1% of total energy

Monounsaturated fatty acids (MUFAs) By differenceb

Total carbohydrate 55–75% of total energyc

Free sugarsd <10% of total energy

Protein 10–15% of total energy

Cholesterol <300 mg per day

Sodium chloride (sodium) <5 g per day

(<2 g per day)

Fruits and vegetables ≥400 g per day

Total dietary fi ber >25 g per day

Non-starch polysaccharides >20 g per day

a WHO Technical Support Series No. 916.

b MUFAs are calculated as total fat minus saturated plus polyun-

saturated plus trans fatty acids).

c Energy from carbohydrate is the percentage energy available after

taking into account that consumed as fat and protein.

d Free sugars refers to all monosaccharides and disaccharides added

to foods by the manufacturer, cook, or consumer, plus sugars natu-

rally present in honey, syrups, and fruit juices. It does not include

sugars present in milk, fruit and vegetables.