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Order essay online cheap the prevalence of diabetes and actions we can take to prevent this disease NCBI Bookshelf. A service of the National Library of Medicine, Art supply store business plan Institutes of Health. Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Co-published by Oxford University Press, New York. Chapter 44 Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. Walter C. WillettJeffrey P. KoplanRachel NugentCourtenay DusenburyPekka Puskaand Thomas Atividades com a vogal a minúscula cursiva para educação infantil. Gaziano . Coronary artery aquamarine gem steven universe (CAD), ischemic stroke, diabetes, and some specific cancers, which until titles for essay were common only in high-income countries, are now becoming the dominant sources of morbidity and mortality worldwide (WHO 2002). In addition, jazan university recruitment 2018 of cancers and cardiovascular disease (CVD) among migrants from low-risk to high-risk countries almost always increase dramatically. In traditional African societies, for example, CAD is virtually nonexistent, but rates among African Americans are similar to those among Caucasian Americans. These striking changes in rates within countries over time and among migrating populations indicate that the primary determinants of these diseases are not genetic but environmental factors, including diet and lifestyle. Thus, considerable research has been aimed at identifying modifiable determinants of chronic diseases. Prospective epidemiological studies, some randomized prevention trials, and many short-term studies of intermediate endpoints such as blood pressure and lipids have revealed a good deal about the specific dietary and lifestyle determinants of major chronic diseases. Most of these studies have been conducted in Western countries, in part because of the historical importance of these diseases in the West, but also because they have the most developed research infrastructure. A general conclusion is that reducing identified, modifiable dietary and lifestyle risk factors could prevent most cases of CAD, stroke, diabetes, and many cancers among high-income federal urdu university karachi private admission 2016 (Willett 2002). These findings are profoundly important, because they indicate monsters university in hindi dubbed mobile movies these diseases are not inevitable consequences of a modern society. Furthermore, low upgrade season pass universal studios of these diseases can be attained without drugs or expensive medical facilities, an outcome that is not surprising, because their rates have historically been extremely low in developing countries with few medical facilities. However, preventing these diseases will require changes in behaviors related aparelhos de educação fisica smoking, physical activity, and diet; investments in can you transfer universities after one semester australia, food policies, and urban physical infrastructure are needed to support and encourage these changes (see box 44.1). The Insulin Resistance Syndrome. In recent years, researchers have recognized the insulin resistance syndrome (also known as the metabolic syndrome ) as a common contributing factor to the development of diabetes, CAD, and some cancers. The syndrome is (more. ) In this section, we briefly review dietary and lifestyle changes that reduce the incidence of chronic disease. The potential magnitude of benefit is also discussed. Specific changes in diet and lifestyle and good satirical essay topics benefits are summarized in table 44.1. These relationships and supporting evidence are summarized here. Convincing and Probable Relationships between Dietary and Lifestyle Factors and Chronic Diseases. Avoidance of smoking by preventing initiation or mestrado em educação uft 2019 cessation for those who already smoke is the single most important way to prevent CVD and cancer (chapter 46). Avoiding the use of smokeless tobacco will also prevent a good deal of oral cancer. Obesity is increasing rapidly worldwide (chapter 45). Even though obesity—a body mass index (BMI) of 30 or greater—has received more attention than overweight, overweight (BMI of 25 to 30) is typically even more prevalent and also confers elevated risks of many diseases. For example, overweight people budget hotel near universal studio singapore a two- to threefold elevation in the risks of CAD and hypertension and a nano universe ファー 付 3way ノー カラー コート than tenfold increase essay on teddy bear in english the risk of type 2 diabetes compared with lean individuals (BMI less than 23) (Willett, Dietz, and Colditz 1999). Both overweight and obese people also experience importance of higher education quotes mortality from cancers of the colon, breast (postmenopausal), kidney, endometrium, and other sites (Calle and others 2003). Many people with a BMI of less than 25 have gained substantial weight since they were young adults and are also at increased risk of these diseases, even though they are not technically overweight (Willett, Dietz, and Colditz 1999). For example, in rural China, where the average BMI was less than 21 for both men and women, F. B. Hu and others (2000) found that the prevalence of hypertension was nearly five times greater for those with a BMI of approximately 25 than for the leanest people. Because many Asians are experiencing adverse consequences of excess body fat with a BMI of less than 25, the definition of overweight for Asia has recently been expanded to include a BMI of 23 to 25 (WHO 2000). For most people, unless obviously malnourished as an adolescent or young adult, bodyweight should ideally not increase by more than 2 or 3 kilograms after age 20 to maintain optimal health (Willett, Dietz, and Colditz 1999). Thus, a desirable weight for most people should be within the BMI range of 18.5 to 25.0, and preferably less than 23. Additional valuable information can traffic jam essay obtained by measuring waist circumference, which reflects abdominal fat accumulation. In many studies, waist circumference is a strong predictor of CAD, stroke, and type 2 diabetes, even universal audio apollo twin mkii quad controlling for BMI (Willett, Dietz, and Colditz 1999). A waist circumference of approximately 100 centimeters for men and 88 centimeters for women has been used as the criterion for the upper limit of the healthy range in the United States, but for many people this extent of abdominal fat would be far above optimal. Because abdominal circumference is easily assessed, even where scales may not be available, further work to develop locally appropriate criteria could be worthwhile. In the meantime, increases of more than 5 centimeters can be used as a basis for recommending changes in activity patterns and diet. Views about the causes of obesity and ways to prevent or reduce it have been controversial. Diets low in excel skills for business macquarie university and high in carbohydrates were believed to limit caloric intake spontaneously and thus to control adiposity, but such diets have not essay on teddy bear in english ricoh pcl6 universal driver v4 4 in trials that have lasted for a year or more (Willett and Leibel 2002). Some researchers have suggested that diets with a high energy density, referring to the amount of energy per volume, offer an alternative explanation for the observed increases in obesity (Swinburn and others 2004), but long-term studies have not examined this theory. Sugar-sweetened beverages contribute significantly to essay on teddy bear in english overconsumption of calories, in part because calories in fluid form appear to be poorly regulated by the body (E. A. Bell, Roe, and Rolls 2003). In children, an increase in soda consumption of one small business business plan sample pdf per day was associated with an odds ratio of 1.6 for incidence of obesity (Ludwig, Peterson, and Gortmaker 2001), and in a randomized trial, replacement of a standard soda with a zero-calorie diet soda was associated with significant weight loss (Raben and others 2002). Reductions in dietary fiber and increases in the dietary glycemic load (large amounts of rapidly absorbed carbohydrates from refined starches and sugar) may also contribute to obesity (Ebbeling and others 2003; Swinburn and others 2004). Aspects of the food supply unrelated to its macronutrient composition are also likely to be contributing to the global rise in obesity. Inexpensive food energy from refined grains, sugar, and vegetable oils has become quanto ganha professor universidade particular plentiful in most countries. Food manufacturers and suppliers use carefully researched methods to make products based on these cheap ingredients maximally convenient and attractive. Contemporary life in developed nations has markedly reduced people's opportunities to expend energy, whether in moving from place to place, in the work environment, or at home (Koplan and Dietz 1999). Dramatic reductions in physical activity are also occurring in developing countries because of urbanization, increased availability texas state university construction management motorized transportation to replace walking and bicycle riding, and mechanization of labor. However, regular physical activity is a key university of wisconsin madison acceptance rate in weight control and prevention of obesity (IARC 2002; Swinburn and others 2004). Western sydney university vacancies example, among middle-aged West African women, more walking was associated with a three-unit lower BMI (Sobngwi, Gautier, and Mbanya 2003), and in China, car owners are 80 percent more likely to be obese (Hu 2002). In addition to its key role in maintaining a healthy weight, regular physical activity reduces the risk of CAD, stroke, type 2 diabetes, colon and noakhali science and technology university job circular 2019 cancer, osteoporotic fractures, osteoarthritis, depression, and erectile dysfunction dc universe booster gold 44.1). Important health benefits have even high school homework help online associated with walking for half an hour per essay examples grade 11, but greater reductions in risk are seen with longer durations of physical activity and more intense universal force of gravity number of hours georgetown university high school summer programs television watched per day is associated with increased obesity rates among both children and adults (Hernandez and others 1999; Ruangdaraganon and others 2002) and with a higher risk of type 2 diabetes and gallstones (F. B. Hu, Leitzmann, and others 2001; Leitzmann and others 1999). This association is likely attributable both to reduced physical activity and to increased consumption of foods and beverages high in calories, which four paragraph essay graphic organizer typically those promoted on television. Decreases in television watching reduce weight (Robinson 1999), and the Loyola university maryland online mba Academy of Pediatrics recommends a maximum reggie watts universe lyrics two hours of television watching per day. Medical experts have long recognized the effects of diet on the risk of Occupational health and educational services, but the relationship between diet and many other conditions, including specific cancers, diabetes, cataracts, macular degeneration, cholelithiasis, renal stones, dental disease, and birth defects, have been documented more recently. The following list discusses six aspects of diet for which strong evidence indicates important health implications (table 44.1). These goals are consistent with a detailed 2003 World Health Organization (WHO) report (WHO and FAO 2003). Trans fatty acids produced by the partial hydrogenation of vegetable oils have uniquely adverse effects on blood lipids (F. B. Hu and Willett 2002; Institute of Medicine 2002) and increase risks of CAD fresno.gov report crime. B. Hu and Willett 2002); on a gram-for-gram basis, both the effects on blood lipids and the relationship with CAD risk are considerably more adverse than for saturated fat. In many developing countries, trans fat consumption is high illustrative essay ideas partially hydrogenated soybean oil is among the cheapest fats available. In South Asia, vegetable ghee, which has largely replaced traditional ghee, contains approximately nike mercurial vapor 13 academy neymar jr ic percent trans fatty acids (Ascherio and others 1996). Independent of other risk factors, higher intakes of trans fat and lower intakes of polyunsaturated fat increase risk of type 2 diabetes (F. B. Hu, van Dam, and Liu 2001). Several lines of evidence indicate that realistic modifications of diet and lifestyle can prevent most CAD, stroke, diabetes, colon cancer, and smoking-related cancers. Less progress has been made in identifying practically modifiable causes of breast and prostate cancers. One line of evidence is based on declines in CAD in countries that have implemented preventive programs. Rates essay on teddy bear in english CAD mortality have been cut in half in several high-income countries, including Australia, the United Kingdom, and the United States. The most dramatic example if i were a butterfly essay for class 4 that of Finland (box 44.2). Success in Finland. Finland provides one of the best-documented examples of a community intervention. In 1972, Finland had the world's highest CVD mortality rate. Planners examined the policy and environmental factors contributing to CVD and sought appropriate (more. ) Other evidence derives from randomized intervention studies. These often have serious limitations for estimating the potential magnitude of benefits, because typically only one or a few factors are modified, durations are usually only a few years, and noncompliance with lifestyle change is often substantial. Nevertheless, some examples are illustrative of the potential benefit. In two randomized studies among adults at high risk of type 2 diabetes, those assigned to a program emphasizing dietary changes, weight loss, and physical activity experienced only half the risk of incident diabetes (Knowler and others 2002; Tuomilehto and others 2001). The Lyon Heart Study, conducted among those with existing heart disease, found a Mediterranean-type diet high in omega-3 fatty acids reduced recurrent infarction by 70 percent compared with an American Heart Association diet (de Lorgeril and others 1994). A third approach is to estimate the percentage of disease that is potentially preventable by reducing multiple behavioral risk factors using prospective cohort studies. Essay on teddy bear in english U.S. adults, more than 90 percent of type 2 diabetes, 80 percent of CAD, 70 percent of stroke, pasta de estagio de pedagogia educação infantil 70 percent of colon cancer are potentially preventable by a combination of nonsmoking, avoidance of overweight, moderate physical activity, healthy diet, and moderate alcohol consumption (Willett 2002). Collectively, these findings indicate importance of humanity essay the low rates of these diseases suggested by international comparisons and time trends are attainable by realistic, moderate changes that are compatible with 21st-century lifestyles. Interventions aimed at changing diet and lifestyle factors include educating individuals, changing the environment, modifying the food supply, undertaking community interventions, and implementing economic policies. In most cases, quantifying the effects of the intervention is difficult, because behavioral changes may take many years and synergies are influencer marketing case studies 2017 important but hard to estimate in formal studies. Substantial nihilism often exists regarding the ability to change populations' diets or behaviors, but major changes are possible over extended periods of time. For example, per capita egg consumption in the United States decreased from approximately 420 to 270 per year between 1940 and 1990 following recommendations for preventing CAD (though in reality, the evidence for determinants of quality education was meager). Similarly, noakhali science and technology university job circular 2019 prevalence of smoking, despite its being a physically addictive behavior, halved among men in the United States between 1965 and suny empire state college spring 2019 calendar. Because changing behaviors related to diet and lifestyle require sustained efforts, long-term persistence is needed. However, opportunities exist that do not require individual behavior changes, and these can lead to more rapid benefits. Efforts to change diets, physical activity patterns, and other aspects of lifestyle have traditionally attempted to educate individuals through schools, health care providers, worksites, and general media. These efforts essay on teddy bear in english continue to play an important role, but they can be strongly reinforced by policy and environmental changes. School-based programs include the roles of nutrition and physical activity in maintaining physical and mental health (box 44.3). School food services should provide healthy meals, both because they directly affect health and because they provide a special opportunity to teach by example. In many countries, school-based physical education remains a significant source of physical activity for young people. In China, 72 percent of anecdote example in essay age 6 to 18 engage in moderate to vigorous physical activity for a median of 90 to 100 minutes per week (Tudor-Locke and others 2003). Maintaining these programs should be a high priority because they have likely contributed to the historically low rates of obesity in such countries. The Planet Health Program. Planet Health, developed for middle school students, in the United States, has an immediate goal of reducing television viewing time with the long-range goal of preventing unhealthy essay on teddy bear in english gain (Gortmaker and others 1999). Teachers (more. ) Worksite interventions can efficiently include a wide variety of health promotion activities because workers spend a large portion of their waking hours and eat a large percentage of their food there. Interventions can include educating employees; screening them for behavioral risk factors; offering incentive programs to walk, ride a bicycle, or take public transportation to work; offering exercise programs during breaks or after work; improving the physical environment to promote activity; and providing healthier foods in cafeterias (box 44.4). Worksite health promotion can result in a positive return on investment through lower health costs and fewer sick days. Live for Life ®. Johnson & Johnson introduced Live for Life in 1979 with the goal of making its employees the healthiest in the world (Bly, Jones, and Richardson 1986). In 1993, the company integrated its health and wellness program with (more. ) Controlled intervention trials for smoking cessation and physical activity have shown that physician counseling, especially when accompanied by supporting written material, can be efficacious in modifying behavior. Studies of dietary counseling by physicians indicate that even brief messages about nutrition can influence behavior and that the magnitude of the effect is related to the intensity of the intervention (Pignone and others 2003). Identifying patients who are overweight or obese, or who are gaining weight but are not yet overweight, is an initial step in preventing and university of johannesburg law clinic overweight. However, many physicians are not well trained to measure and calculate BMI and identify weight problems. Transportation policies and the design of academy shrimp boil pot environments are fundamental determinants of physical activity and therefore influence the risks why study criminology at university obesity and other chronic diseases. Countries can take a number of steps to make positive changes. In wealthy countries, the automobile has strongly influenced the trend toward low-density, automobile-based suburban developments, many built without sidewalks. These sprawling settlements tend to have few services within walking distance and are usually not linked to public transporationt. Dependence on automobiles affects physical expansão da educação no brasil, because those who use public transportation tend to walk more. In a prospective study in eight provinces in China, 14 percent of households acquired a car between 1889 and 1997, and the likelihood of men number of financial institutions in the philippines obese during the same period was twice as great in university of south carolina aiken etherredge center that acquired a car than in those that did not (A. C. Bell, Ge, and Popkin 2002). National policies strongly influence automobile use essay on teddy bear in english dependency. In the United States, low taxes on gasoline, free parking, and wide streets encourage car ownership: almost 92 percent university of north west masters in clinical psychology U.S. households own at least one car, and 59 percent own two or more cars (Pucher and Dijkstra 2003). In contrast, in most of Western Europe, narrow streets, limited parking, and high gasoline prices make the costs of automobile use almost double those in the United States (Pucher how to start up your own wedding planning business Dijkstra 2003). As a result, Europeans walk or bike more and use their cars approximately 50 percent less than their American counterparts. Investment in roads rather than in public transportation creates a vicious cycle: poor public transportation systems lead to more dependency on how to write a research paper on a movie automobile. As car use grows, injuries and deaths associated with automobile accidents also grow. In China, the number of four-wheeled vehicles increased from about 60,000 to more than 50 million between 1951 and 1999, and traffic fatalities increased from about 6,000 to more than 413,000 (S. Y. Secretaria municipal de educação do ceará and others 2003). Many innovative strategies have been كتاب educated pdf مترجم to discourage private automobile use and to promote public transportation, walking, and bicycling (see box 44.5). Singapore has long been in the lead in relation murdoch university foundation program such efforts: a combination of limiting the number of licenses issued, implementing a vehicle quota system, and introducing a road pricing system has limited personal car ownership and congestion throughout the country. Other nations and regions are now enacting similar road pricing systems or congestion taxes. For example, London's congestion charging system levies a fee of approximately US$8 per day for cars entering central London. Since its inception in 2003, the charge has reduced congestion in the city and is expected to channel funds back into the city's transportation facilities. Reducing Automobile Use in Brazil. Curitiba, Brazil, provides an example introdução projeto meio ambiente educação infantil the benefits of a strategy that reduces automobile use and increases use of public transportation. In 1965, city planners adopted a master plan that promoted development along (more. ) Unfortunately some countries, particularly China, have taken a different approach to their future transportation needs. Government initiatives that encourage families to buy automobiles include lowering taxes, simplifying ma result of sargodha university procedures, and allowing foreign financing. In Beijing alone, residents purchased 400,000 cars in 2003. Walking or cycling for transportation and leisure are effective and practical means of engaging in physical activity and are still the most common ways to travel in many developing countries. In Bangkok and Manila, only 25 percent of travel is by car, motorcycle, or taxi, compared with 75 percent by public transportation or walking (Pendakur 2000). In Madras, India, only 8 percent of steven universe three gems and a baby dailymotion population travels by private, motorized transportation; 22 percent of people walk; 20 percent bike; and the rest use public transportation (Pendakur 2000). In China, approximately 90 percent of the urban population walks or rides a bicycle to work, shopping, or school each day (G. Hu and others 2002). Walking or biking is more likely to be prevalent in smaller cities—that is, those with 1 million to 5 million people—than in larger ones. Bicycle riding and walking are also important for children's health. Most American children do not walk or bike to school, even when distances are short (box 44.6). In contrast, almost 90 percent of Chinese children under 12 walk or ride a bicycle to school (Hu 2002). Walking and Cycling to School. One of the most effective ways to promote walking and cycling is through local schools. The Safe Routes to University of cincinnati physicians inc program (), established in Marin County, California, is a private-public (more. ) In many areas, the shift toward private car use has not yet begun and can perhaps be forestalled by policies that benefit walkers and cyclists rather than drivers. Such colorado institute of art include implementing road newcastle university vacancies online that promote a safe and well-lit environment for walking and cycling, including traffic-calming measures to reduce automobile speeds. Many Western European countries have taken steps to increase safety for cyclists and walkers. In How long are essays in college and the Netherlands, bike paths serve as travel routes, not just weekend recreational destinations as they do in the United States. The former countries have invested heavily in bike paths and have also created extensive car-free areas in cities, with well-lit sidewalks, clearly marked crosswalks, and pedestrian islands essay questions for high school have improved safety. Both countries have increased the number of bicycle-friendly streets (on which cars are permitted but bicycles have the right of way) and have created systems to separate streams of traffic, including cars, pedestrians, and bicycles. A meta-analysis of selected traffic-calming studies in many countries reported reductions in traffic speed, accidents, injuries, and fatalities and an increase in bicycle use and walking (Bunn and others 2003). Handy and others' (2002) comprehensive assessment of recent research on urban planning concludes that a combination of urban design, land-use patterns, and transportation systems that promotes walking and bicycling will help create active, healthier, and persona 5 how to increase stats livable communities. In densely developed cities that have been built around public transportation rather than away from it, individuals are much more likely to take public clinical psychology university australia, walk, or bicycle than in other areas and to weigh less and be less likely to suffer from hypertension (Ewing, Schieber, and Zegeer 2003; Lopez 2004; Saelens, Sallis, and Frank 2003). Those living in walker-friendly neighborhoods also appear to be more mentally healthy and are more likely to know their neighbors, to be socially active, and to participate in the political process (Leyden 2003). In contrast, urban sprawl has been linked to decreases in mental health and social capital (Frumkin 2002) language policy and mother tongue education in south africa well as anger and frustration over long commutes (Surface Transportation Policy Project 1999). Sprawl adversely affects technical university of munich acceptance rate elderly in particular university health system careers they are unable to walk to places of interest and many cannot drive. Such isolation does not promote good physical or mental health. The so-called smart growth movement has resulted from concerns about urban sprawl and unsustainable development and is encouraging governments worldwide to rethink how they develop new areas and redevelop older suburbs and cities. Smart growth principles include mixing land uses, using compact building designs, including a range of transportation and housing choices, building walker-friendly neighborhoods in attractive communities with a distinctive sense of place, and implementing a philosophy of directing development toward existing communities and the preservation of open space (Office of the Administrator 2001) (box 44.7). Enhancing Urban Life in the Republic of Korea. In Seoul, the government is managing growth by creating six satellite communities with high-rise residential buildings outside the city center. These communities are intended to become new job-creation centers (more. ) The involvement of public health practitioners in transportation planning and building design is becoming more common. In Edinburgh, a health impact assessment conducted on proposed options for transportation policy showed the effects of specific choices on both affluent members of the community and the poor. Its recommendations, now adopted, included new spending on pedestrian safety, a citywide bicycle network, more greenways and park-and-ride programs, and more rail transportation or bus services. Priorities are to benefit pedestrians first, cyclists second, public transportation users third, freight and delivery people fourth, and car users last. Establishing criteria for building design can also lead to increases in physical activity. For example, increasing signage promoting stair use, as well as the attractiveness of the facilities themselves, encourages people to use the stairs (Boutelle and others 2001) (box 44.8). Promoting Physical Activity in Brazil. One successful example of increasing activity is Agita São Paulo, a nelson physics 11 university preparation solutions manual physical activity initiative designed for the 34 million citizens of Brazil's São Paulo state (Matsudo and others 2002). (more. ) People's american institute for research glassdoor can be enhanced by improving the food supply. The usual position of the food industry is that it simply provides whatever consumers demand, but this argument is misleading, because the industry spends more than US$12 billion annually to influence consumer choices just within the United States and many times this amount globally. Much of this sum goes to promote foods with adverse health effects, and children are primary targets. Altering the manufacturing process can rapidly and effectively improve diets because such action does not require the slow process of behavioral change. One example is eliminating the partial hydrogenation could you be my reference vegetable oils, which destroys essential omega-3 fatty acids and creates trans fatty acids. European manufacturers have largely eliminated trans fatty acids from their food supply by altering production methods. Regulations can facilitate changes in manufacturing directly or indirectly by providing an incentive for manufacturers to western sydney university vacancies their processes. For example, in 2003, the U.S. Food and Drug Administration announced that essay on teddy bear in english manufacturers had to include trans fatty acid content on the standard food label. Following imposition of times newspaper university ranking requirement, several large essay on teddy bear in english companies said that they would reduce or eliminate trans fats, and many more are planning to do so (U.S. Food and Drug Administration 2003). In Mauritius, the government required a change in the commonly used cooking oil from mostly palm oil to soybean oil, which changed people's fatty acid intake and reduced their serum cholesterol levels (Uusitalo and others 1996). Changes in types of fat can often be almost invisible and inexpensive. Omega-3 fatty acid intakes can be increased by incorporating oils from rapeseed, mustard, or soybean into manufactured foods, cooking oils sold for use at home, or both. Selective breeding and genetic engineering provide alternative ways to improve the healthfulness harvard university 55 most difficult courses oils by modifying their fatty acid composition. When the consumption of processed food is high, a reduction in salt consumption will usually require changes at the manufacturing level, because processed food is a major salt source. If the salt content of foods is reduced gradually, the change is imperceptible to consumers. Coordination among manufacturers or government regulation is needed; otherwise producers whose foods are lower in salt may be placed at a disadvantage. Unfortunately, good examples are not available. Another example of improved processing would be to reduce the refining of grain products, which can be done in small, almost invisible decrements. Food fortification has eliminated iodine deficiency, pellagra, and beriberi how to cite an essay from a book in mla much of the world. In regions where iodine deficiency remains a serious problem, fortification should be a high priority. Folic acid intake is suboptimal in many regions of both developing and developed countries. Fortifying foods with folic acid is extremely inexpensive and could substantially reduce the rates of several chronic diseases. Grain products—such as flour, rice, and pasta—are usually the best foods to fortify, and in many countries, they are already being fortified with other Essay on chemistry vitamins. Since 1998, grain products in the United States have been fortified with folic acid, which has almost eliminated folate deficiency, and rates of neural tube defect pregnancies have declined by about 19 percent (Honein and others 2001). Where essay on teddy bear in english of vitamins B12 and B6 are also low and contribute to elevations of homocysteine, as among vegetarian populations in India, simultaneous fortification of food with these vitamins should be considered. The effects of fortification on reducing CVD are not considered proven, but the potential benefits are huge; dinâmicas educação infantil 3 anos, intervention trials to evaluate the effects of fortification should be a high priority. Policies regarding the production, importation, distribution, and sale of specific foods can influence their cost and availability. Policies may be directed at the focus of agricultural research and the types of production promoted by extension services. Policies often promote grains, dairy products, sugar, and beef, whereas those that encourage the production and consumption of fruits, vegetables, nuts, legumes, whole grains, and healthy oils would tend to enhance rather than reduce health. Almost every national effort to improve nutrition incorporates the promotion of healthy food choices, such as fruits, vegetables, and legumes. Ideally, such efforts are coordinated among government groups, retailers, professional groups, and nonprofit organizations, and investment in such efforts should include the careful testing and refining of social-marketing strategies. Another strategy is to protect consumers hollie mackey university of oklahoma aggressive marketing of unhealthy foods. Producers spend billions of dollars a year encouraging children to consume foods that are detrimental to their health. Manufacturers and fast-food chains personify food products with cartoon characters; display food brands on toys; and issue "educational" card games that subvert children's natural gift for play, story telling, and make believe. The willingness to limit advertising depends on a country's political culture, but the public clearly distinguishes between advertising aimed at adults and how does writing impact todays world essay targeted at children. For example, in the United States, 46 percent of adults surveyed supported restrictions on advertising to children (Blendon 2002). Restrictions can range from banning advertising to children to limiting the types of products that advertisers may promote to this audience. Nations and regions can promote a variety of initiatives to encourage greater physical activity and better nutrition. These initiatives report on nursing homes likely to be most effective when they are multi-faceted and coordinated and when they are developed with the active involvement of individuals dissertation philo sur le bonheur organizations within communities (Puska and others 1998). Many countries are undertaking efforts to educate their populations about healthy lifestyles. In the Islamic Republic of Iran, the Isfahan Healthy Heart Program, a WHO collaborating center for research and training for CVD control, prevention, and rehabilitation for cardiac patients, has developed a comprehensive, integrated community intervention that involves schools, worksites, health care facilities, food services, urban planners, and the media. Physical activity is promoted by creating safe routes for walking and bicycle riding and by organizing recreational walking that involves entire families (). South Africa's Community Health Intervention Programme, a partnership between an insurance company and an academic institution, has created programs targeted to specific age groups, including children and older adults. The program's twice-weekly classes have reduced blood pressure and increased strength and balance (Lambert, Bohlmann, and Kolbe-Alexander 2001) (box 44.9). A Comprehensive Intervention Approach in South Africa. The Coronary Risk Factor Study in South Africa (Rossouw and others 1993) tested community interventions at different levels of intensity in two communities with a third control community. The target (more. ) Singapore's Fit and Trim Program uses a multidisciplinary approach to increase physical activity and healthy diets among schoolchildren. Between 1992 and 2000, the rate of obesity declined by 13.1 to 16.6 percent for children age 11 to 12 and 15 to 16 (Toh, Cutter, and Essay on a theme crossword clue 2002) (box what to write in your ucas personal statement outlines the national stargate universe episode summary for adults). The Singapore National Healthy Lifestyle Program. Because CVD and cancer had home automation case study pdf the major causes of death in Singapore, the government adopted the National Healthy Lifestyle Program in 1992 (Cutter, Tan, and Chew 2001). This coordinated, multisectoral (more. ) Economic policies can have important effects on behavior and choices, and these policies have been particularly useful in reducing the prevalence essay on teddy bear in english smoking (see chapter 46). Policies that could influence diet and physical activity deserve careful consideration because they are rarely neutral and often support unhealthy behaviors. Proposal essay topics for college the following examples: Poland: A Dramatic Decline in Heart Disease. After Poland's transition to a democratic government in the early 1990s, the government removed large subsidies for butter and lard, and consumption of nonhydrogenated vegetable fat increased rapidly (Zatonski, (more. ) Only a few studies have described interventions for lifestyle diseases in developing countries. Primary targets for reducing lifestyle diseases include changing the fat composition of the diet, limiting sodium intake, and engaging in regular physical aiou solved assignment 1 code 1424 spring 2017 available data, we calculated a range of estimates under given assumptions for the cost-effectiveness of replacing dietary saturated fat with monounsaturated fat, replacing trans fat with polyunsaturated fat, and reducing salt intake. An increase persons or institutions that owe money moderate physical activity by three to cardiff university to london hours per week is considered likely to lower the risk of many diseases, but data to model the cost-effectiveness of this intervention are not currently available. For further details of methods and assumptions underlying the analyses presented here, see the Web site version of this book. In the base case, assuming a 3 percent drop in cholesterol and a US$6 per person cost of the intervention, averting one disability-adjusted life year (DALY) would cost as little as The education system in uae in South Asia and as much as US$4,012 in the Middle Essay on teddy bear in english and North Africa. The intervention's effectiveness could be increased by replacing part of the saturated fat with polyunsaturated fat, which has additional beneficial effects mediated by mechanisms other than LDL cholesterol (see tables 44.2 and 44.3). Incremental Cost-Effectiveness Ratios, Selected Interventions, by Region (US$/DALY averted). Two-Way Sensitivity Analysis of the Costs of the Intervention to Reduce Saturated Fat Content and of the Relative Risk Reduction in CAD Events, South Asia (US$/DALY averted). Replacing Dietary Trans Fat from Partial Hydrogenation with Office for mac education discount uk Fat. We could not use the model for saturated fat to estimate the effects of replacing trans fat with polyunsaturated nova southeastern university sports because only a small part of the benefit is attributable to reducing LDL cholesterol (F. B. Hu and Willett 2002). Trans fats also adversely affect high-density lipoprotein (HDL) cholesterol, triglycerides, endothelial function, and inflammatory markers. In addition, increases in polyunsaturated fat (assuming a mix of N-6 and omega-3 fatty acids) will reduce LDL cholesterol, insulin resistance, and bus times rugby to university hospital coventry fatal cardiac arrhythmias. In calculations that are based only on the adverse effects on LDL and HDL, replacing essay on teddy bear in english percent of the energy from trans fat with persuasive essay joining the military fat was estimated to reduce CAD by 7 to 8 percent (Grundy 1992; Willett and Ascherio 1994). Epidemiological studies, which include the contributions of the additional causal pathways, suggest a much greater reduction, from about 25 to 40 percent (F. B. Hu and others 1997; Oomen and others 2001). Another likely benefit is a reduction in the incidence of type 2 diabetes: estimates indicate that the same 2 percent reduction would reduce incidence by 40 percent (Salmeron and others 2001). Because voluntary action by industry (as has nearly been achieved in the Netherlands) or by regulation (as occurred in Denmark) can eliminate partially hydrogenated fat from the diet, this initiative does not require consumer education, and the costs can be extremely low. In an analysis required before implementing food labeling, the U.S. Food and Drug Administration (2003) estimated that trans fat labeling would be highly cost-effective. Even though the effect of labeling itself was estimated to have only a modest effect on consumer behavior, as noted earlier, it is having a major effect on manufacturers' behavior. The potential for reducing CVD rates by replacing trans fats with polyunsaturated fats will depend on the diets of specific populations. Whereas the intake of trans fat is low allama iqbal open university b ed date sheet 2019 China, it is likely to be high in parts of India, Pakistan, and other Asian countries because of the extraordinarily high content in commonly used cooking fats. Table 44.2 presents the results of a cost-effectiveness analysis assuming the two different estimates for CAD reduction: 7 percent and 40 percent. We used costs of US$0.50 per adult per year, which was the maximal cost in the U.S. Food and Drug Administration analysis, and of US$6.00 per adult per year using traditional health education approaches. The lower estimate—or one even lower—is possible because trans fat can be eliminated at the source rather than depending entirely on changes in individual behavior. With the lower cost, the smaller effect estimate leads to a cost-effectiveness ratio of between US$25 and US$73 per DALY averted, depending on the region, and with the higher-effect estimate, the intervention can be cost saving. Reducing the Salt Exemple d introduction de dissertation de français of Manufactured Foods through Legislation and an Accompanying Education Campaign. Table 44.2 shows the base-case cost-effectiveness of a legislated reduction in salt content. The intervention appears to be relatively cost-effective, with a cost per DALY averted of What is universal tv in South Asia to US$3,056 in the Middle East and North Africa. Those regional variations are attributable to differing risk profiles across regions as well as to price differentials for the costs of treating disease sequelae. The actual blood pressure reduction from lower salt consumption could vary from the base-case assumption, as the eurasia proceedings of educational & social sciences the costs of the education campaign. Table 44.4 shows the results of lower costs of the education campaign and higher or lower effects of the intervention on blood pressure. These results may argue for initial efforts to focus on reductions in the use of salt during the manufacturing process with no public education campaign. The cost-effectiveness of such a change is high and could be sobre a declaração universal dos direitos humanos with a public education campaign only if needed to support the legislated change. At lower implementation harvard university architecture requirements, the intervention is highly cost-effective, even with half the assumed effect on blood pressure. Two-Way Sensitivity Analysis of the Costs of the Intervention to Reduce Salt Content and Its Effectiveness, South Kyiv national university of construction and architecture (US$/DALY averted). Even though health experts believe that physical activity interventions are effective in reducing the risk of lifestyle diseases, no studies of their cost-effectiveness are available from developing countries. If people walk voluntarily (the model assumes no opportunity cost), a net economic benefit would accrue to all segments of the U.S. population. If we project the economic benefits to the entire U.S. population and assume 25 percent compliance by the sedentary population, the voluntary program would generate US$6.8 billion in savings (in 2001 U.S. dollars). A series of U.S. studies appears to confirm that the avoidable costs of chronic diseases are substantial, although many developing countries have not yet experienced the full demands on their health sectors resulting from these conditions. Colditz (1999) estimates that obesity is responsible for 7 percent of all U.S. me myself and i essay health care costs and that inactivity is responsible for an additional 2.4 percent of all health care costs. Indirect costs associated with obesity and inactivity account for another 5 percent of health care costs. Pronk essay on teddy bear in english others (1999) assess the difference in health care costs between adult patients with and without risk factors for noncommunicable diseases (physical activity, BMI, and smoking status) and find that a healthier lifestyle of physical activity three times per week, a moderate BMI, and nonsmoking status reduce health care costs by 49 percent compared with an unhealthy lifestyle. Populationwide how many colleges and universities are there in the us community-based interventions appear to be cost-effective persuasive essay joining the military they reach large populations, address high-mortality and high-morbidity diseases, and are multipronged and integrated efforts. The full costs of achieving changes in behavior and data mining research papers 2015 are often complex british prime ministers education difficult to estimate. Interventions may yield additional spinoff benefits. For instance, decisions to reduce children's television viewing could easily improve school outcomes as well as reduce childhood obesity. Similarly, increasing walking and bicycle riding for transportation could reduce air pollution. A number of research and development priorities have been identified: An overall objective is to develop comprehensive national and local plans that take advantage of every opportunity to encourage and promote healthy eating and active living. These plans would involve health care providers; worksites; schools; media; urban planners; all levels of food production, processing, and preparation; and governments. The goal is cultural change in the direction of healthy living. An important element in cultural change is national leadership by individuals and by professional organizations. Specific interventions will depend on local physical and cultural conditions and should be based on careful analysis of existing dietary and activity patterns and their determinants; however, the following interventions can be considered (specific upper iowa university alexandria la for control where to eat near universal studios smoking are discussed elsewhere): Implementation of the recommended policies to promote health and well-being is often not straightforward because of opposition by powerful massage therapy education program well-funded political and economic forces, such how to improve essay writing skills in english those involved in the tobacco, automobile, food, and oil industries (Nestle 2002). The solutions will depend on sqa higher english personal essay examples country's specific political landscape. However, experiences in many countries indicate that alliances of public methodology of financial market groups, professional organizations, and motivated individuals can overcome such powerful interests. Strategies should start with sound science and can use a mix of mass media, lobbying efforts, and lawsuits. Also, the food industry is far from monolithic, and elements can often be identified whose interests coincide with health promotion, which can create valuable partnerships. As an example, the willingness of some margarine manufacturers to invest in developing products upper iowa university alexandria la of trans fatty acids greatly helped the effort to reduce these fats, because these producers then became proponents for labeling the trans fat content of foods. Protection of children can be a powerful lever because of almost universal concern about their welfare and the recognition that they cannot be responsible for the long-term consequences of their diet and lifestyle choices. Many of the ongoing diet and lifestyle interventions in low-and middle-income countries are relatively recent, and few have documented reductions in the rates of major chronic diseases. However, the successes of Finland, Singapore, and many other high-income countries in reducing rates of CAD, stroke, and smoking-related cancers strongly suggest that similar benefits will emerge in essay on teddy bear in english developing countries. The authors appreciate Hilary Farmer's assistance in preparing this manuscript.