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Diseases of overnourished societies and the need for dietary change 

Diseases of overnourished societies and the need for dietary change

Diseases of overnourished societies and the need for dietary change

J.I. Mann

and A.S. Truswell



This chapter has been thoroughly revised, including recent recommendations that allow a wider acceptable range of macronutrient intakes.

Updated on 30 Jul 2015. The previous version of this content can be found here.
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date: 29 April 2017

The nutritional problems of a country depend more upon the stage of technical and economic development than geographical location. People in affluent societies do not have to worry about the problems of getting food and keeping it uninfected. Food is cheap for them, and they can eat their favourite foods all year round: the diet is energy-dense, high in fat and often also in sugar. There are multiple sources of nutritional advice and concerns, with breakthroughs and scares, science and pseudoscience, about all food.

Obesity (see Chapter 11.5) is the most obvious and important nutritional disease in affluent societies, with comorbidities including type 2 diabetes and the many consequences of insulin resistance, coronary heart disease, hypertension, some cancers, gallstones, osteoarthritis, and obstructive sleep apnoea. Obese people may also be disadvantaged by social, economic, and psychological effects. Particular dietary constituents promote or protect against coronary heart disease by their effect on cardiovascular risk factors, and some promote or protect against various cancers.

While those at the highest personal risk are likely to show the greatest individual benefit from dietary and lifestyle changes, national rates of nutrition-related diseases will best be reduced if changes are made by the population at large. The main purpose of such recommendations is to reduce the risk of morbidity and mortality in those who are in the prime of life. Even greater reduction in morbidity and mortality and an improvement in life expectancy may occur in succeeding generations if they have reduced lifetime exposure to risk factors related to lifestyle.

Many different dietary patterns are compatible with widely accepted nutritional recommendations for overnourished societies. More recent recommendations include a wider acceptable range of macronutrient intakes than had previously been suggested. The following statements are representative of universally accepted advice.

All dietary patterns should include a wide variety of foods to ensure a nutritionally adequate diet. ◆ Energy balance is essential for body weight control; energy-dense foods high in fat and sugars should be restricted to avoid excess weight gain. ◆ A wide range of fat (25–40% of total energy) and carbohydrate (45–60% of total energy) intakes is acceptable, provided appropriate food sources predominate. ◆ Saturated fat intake should provide less than 10% of total energy, the remainder from cis mono- and polyunsaturated fat. ◆ Vegetables, fruit, legumes, and pulses (which are also sources of protein) and wholegrain cereals should provide most of the carbohydrate. ◆ Intake of salt and foods rich in salt should be reduced to a maximum of 100 mmol/day of sodium (6 g of NaCl). ◆ Alcohol should be consumed in moderation (one to two drinks/day) by those who choose to drink.

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