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Do We Need 'Global' Uniform Nutrition Guidelines To Specifically Combat Chronic Lifestyle Diseases?

Thursday, August 19, 2010
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DO WE NEED UNIFORM NUTRITION GUIDELINES TO COMBAT CHRONIC LIFESTYLE DISEASES?
Chronic lifestyle diseases are a leading cause of death and have become one of the greatest challenges faced by health care professionals’ world over. Currently, we are facing a double whammy, on one hand, improved medical and health care facilities have resulted in an epidemiological transition towards low mortality rates and increased life expectancy and on the other, we are undergoing a nutrition transition by eating more unhealthy foods. Along with it, other lifestyle factors like physical inactivity and rising consumption of tobacco and alcohol are contributing to unprecedented rise in chronic lifestyle diseases.

Though there are many organizations like the World Health Organization and authorities of public health of different countries, which have addressed the need of issuing global guidelines, there is still lack of co-ordination for the same.

Working in unison will not only result in effective strategy planning of nutrition guidelines by experts from different countries, also, an exchange of ideas and amalgamation of research data from various parts of the world will help to improve the health of millions of consumers across the globe.

But, it is easier said than done. With people of different ethnicities and race having different genetic predisposition and nutritional requirements it would be a mammoth task to frame uniformly effective nutrition guidelines. So, all pros and cons need to be carefully weighed by health care authorities. A consensus needs to be drawn first whether it is even feasible as well as appropriate to draw uniform guidelines or not?

Here, on The NutritionVista Global Dietetic Forum we would like to invite health care professionals to share their views and opinions regarding this issue.

The dietitians at NutritionVista.com

 

NutritionVista

User Comments

02 November, 2010 | Rajiv Basu | Reply

Rajiv Basu Can any one put some light on NUTRILITE ? They claim that they are the most trusted nutritional supplement brand as per Euromonitor report! Is it effective to use this products as supplements?

01 November, 2010 | Rajiv Basu | Reply

Rajiv Basu Can any one sugest me about any correspondence course for Nutrition study? Also pls suggest me how any one can become a registered Nutritionist / Diatetian and become attached with some Nursing homes or can practise individually. My mail id: rajaryanbasu@gmail.com and mobile # 09830415880.

Regards
Rajiv

01 November, 2010 | Vijayalakshmi Iyengar | Reply

Vijayalakshmi Iyengar Hello Rajiv as Mrinal has rightly said, Nutrition & Dietetics is a professional course and it is a 3+2 year study where you learn all about Human Anatomy, Physiology, Diseases and their causes, Diet and its relation to Health and much much more. Reading a book and understanding how diet and supplements work is like us reading books on `Management' to better your lives but we don’t get to become an MBA professional.
Correspondence courses like IGNOU or from different State University`s are good for personal education but not for practicing as a professional. So please do update yourself, read as much as you can on health from authentic websites and original and recommended books and do share the information with your family & friends
Good luck

01 November, 2010 | Mrinal Jhangiani | Reply

Mrinal Jhangiani Rajiv,
The recommended course of study for a practicing / registered dietitian is a MSc in dietetics and then post internships in hospitals one needs to take the RD exam given by the IDA.

Correspondence courses may be available but are inadequate to be a practicing dietitian.
Good luck.

01 November, 2010 | Shiny chandran | Reply

Shiny chandran Hi viji

I agree with you, the fear of over supplementation is always there. Last week i had a doctor visiting me for consultation because of severe gastric problems ,thanks to wrong eating habits and poor hydration. There are physicians who are very well versed in nutrition. The emphasis on nutrition should be strongly emphasised in medical school.

01 November, 2010 | Vijayalakshmi Iyengar | Reply

Vijayalakshmi Iyengar Well Shiny, I do agree with what both you & Geetanjali say, but at the same time we cannot discount that some doctors are good with their nutrition and take extra credit courses for the same and some Dietitians do not take trouble to update themselves and deliver. What would be ideal is as Geetanjali said both the doctor and dietitian concerned is ..discuss ...debate ... synergise . Again on the supplements i think it has to be customised and prescribed case wise as it is required for some and abused by others.

01 November, 2010 | Geetanjali Kelkar | Reply

Geetanjali Kelkar Hi Shiny

I agree with you that medical schools should give emphasis on nutrition education. But I strongly feel the right to impart nutrition education/counseling to patients/clients should be restricted to the nutritionists/dietitians. In a medical set-up dietitians and doctors should work in cohesion and avoid going overboard. After all both the fields are highly specialized and distinct.

01 November, 2010 | Sangeetha Narayana Swamy | Reply

Sangeetha Narayana Swamy I agree with you Geetanjali, diet couseling and planning should be a dietitian/nutritionists job. The doctors and dietitians should work in co-ordination. This will help the patient get the best from both sides.

31 October, 2010 | Rajiv Basu | Reply

Rajiv Basu Thanks a lot Madam Iyenger for the suggestion. Can you pls recommend me 4-5 similar books like that of Dr. Strand? Also please suggest me some audio/video cd regarding the matter. My mail id: rajaryanbasu@gmail.com & mobile # 09830415880.
Regards
Rajiv

29 October, 2010 | RAJIV BASU | Reply

RAJIV BASU Recently I have read "WHAT YOUR DOCTOR DOESN'T KNOW ABOUT NUTRITIONAL MEDICINE MAY BE KILLING YOU" (AUTHOR- RAY D. STRAND, MD). I think every conscious people must read and recommend this book to other conscious people, who are thinking and working on this vast subject.
Regards

30 October, 2010 | Vijayalakshmi Iyengar | Reply

Vijayalakshmi Iyengar Hello Rajiv I second your opinion about that book, it is one of my favorites too.
Dr Strand is Medical doctor who later on did a specialized course in Nutrition.
The only danger is people take it out of context and go over board with supplements (like self medication).
So if you have any health problems or a nutritional deficiency and are on medication, you should talk to the attending doctor about supplementation and then take the call.
Till such time I suggest you eat a well balanced diet and take an extra helping or two of vegetables and it will stand you in good stead. There is always the danger of over supplementation.

29 October, 2010 | Rahul B. Singhal | Reply

Rahul B. Singhal I think some docs know their nutrition stuff and some dont. Those who are certified in nutrition should be able to guide patients on nutrition.

My fathers cardiologist always had a dietitian who he recommended for my dad, so we never really had any issues - she was excellent and knew how to motivate my father to eat better.

Personally speaking, why the heck would you want a doc to waste time giving you food stuff info and guidance when they are clearly rushed with patients packed like sardines in the waiting room.
I think the dietitian visit was very helpful.

29 October, 2010 | Geetha | Reply

Geetha All doctors have a paper on nutrition in their undergrad course. It's that they want to pump the patients with medicines for reasons known to them - i do not know if the patient is benefited, but for sure the doc is :, that is what i feel. Eating a healthy and balanced diet with good exercise definitely helps in all disorders. This is what we all have to understand!

29 October, 2010 | Arushi Nath | Reply

Arushi Nath Why, what happened? did you have a bad experience?

23 September, 2010 | Umayalamanchili | Reply

Umayalamanchili Hi, I like the idea of educating mothers about their childrens health. Many parents especially educated parents provide unhealthy food to their children as they are not able to spend time to cook healthy food for their children. Now we see, two types of children 1. underweight who also love the fast foods and spend money on it and because the mother thinks her child is happy so she indulges and gives Rs1 or 2 to eat which fills their stomachs.

And 2. overweight in high income groups or middle income group who have money to spend and spends on junk food as they have no time to cook because the mother is either a working mother or she is busy attending functions, party or club meetings so again thinks no time so either they buy junk food from restaurants or have cooks prepare them in an unhealthy manner or method of cooking. The mother only thinks that taste is what it does wrong is make these children develop health problem at an early age.

16 September, 2010 | Kanika Jain | Reply

Kanika Jain According to the article "Global Non communicable Diseases - Where Worlds Meet," published in The New England Journal of Medicine in September issue, chronic diseases account for 60 percent of all deaths worldwide and 80% of these deaths occur in low- or middle-income countries. Also, the major risk factors for these diseases e.g. high glucose levels, obesity, and inactivity are all on the rise, especially in developing countries.

Authors have urged policymakers to increase their sense of urgency to stop the global spread of chronic diseases such as heart disease, cancer and diabetes that threaten the health and economies of industrialized and developing nations alike.

It has been projected that in the next 10 years, China, India, and Britain will lose $558 billion, $237 billion, and $33 billion, respectively, in national income as a result of largely preventable heart disease, strokes, and diabetes.

Reference:
http://www.nejm.org/doi/full/10.1056/NEJMp1002024

Thanks and regards,
Kanika Jain
Dietitian
NutritionVista

08 September, 2010 | Purvi Sharma | Reply

Purvi Sharma It may not be possible to form uniform guidelines for the people all across the globe as people belong to different ethnicities so they may be differing in their nutritional requirements. It is more important to bring health care professionals like doctors\diabetes educators\dietitians to join hands and work in unison to fight chronic lifestyle diseases.

08 September, 2010 | Isha Garg | Reply

Isha Garg Hi Renuka,
I agree with you. Though we do have programmes like nutrition week at many places but just confining education programmes to one week would not yield considerable results. It has to be an ongoing process if we have to target global burden like chronic lifestyle diseases.

08 September, 2010 | Renuka | Reply

Renuka Focus should be on implementation of already laid down guidelines. There is still lack of awareness amongst people regarding chronic lifestyle diseases. Nutrition education should be emphasized upon. There should be more of community based programmes like plays or seminars to address this issue.

03 September, 2010 | Kanika Jain | Reply

Kanika Jain Dear Shweta,
This is a very good suggestion given by you. A child spends a considerable part of time in school. It can be a good platform to start nutrition education and inculcate healthy eating habits. So bottom up approach has lot of potential but for this school authorities also have to play active role.
I would like to share my personal experience related to it. When I was studying in primary school, it was made compulsory for us to get green leafy vegetables and seasonal vegetables like carrots\peas in lunch. Initially our class teacher personally used to check our lunch boxes for that. She used to write a note on defaulter’s diary addressed to their parents regarding same (who were used to getting pickles with chapatti or french fries or maggie in the lunch).After few days everybody started getting GLVs in their lunch. Most of us hated this rule but gradually we got used to it. For better implementation and motivation our principal used to give surprise visit and sit with us and eat his lunch and have some from ours too. I still give credit to my healthy eating habits to them first and then my parents.
Thanks and regards,
Kanika Jain
Dietitian
NutritionVista

03 September, 2010 | Shweta Sharma | Reply

Shweta Sharma We should be following bottom-up approach for combating lifestyle diseases.
Foundations of healthy lifestyle are laid down at early age. What about making nutrition, compulsory subject in schools and appointing dietitians there who can conduct workshops or plays or seminars over there to give nutrition education to students?

03 September, 2010 | Mrinal | Reply

Mrinal Shweta,
Yes, you are right about starting nutrition awareness and health educational programs at an early age in elementary schools.
I would like to go a step further and recommend chronic lifestyle disease awareness programs be instated for classes 6-12. Childhood obesity puts children and teenagers on a path that often leads them to obesity in adulthood - thereby increasing their risks for developing diabetes or CVD's.

With regular awareness and serious interventions at least this upward trend can be halted.

Fixing the younger generations one at a time is a good start.

01 September, 2010 | Anastacia W Kariuki-Kenya | Reply

Anastacia W Kariuki-Kenya Well;the lifestyle pandemic is still a great challenge here in Kenya and the larger East-Africa is focused on screening and treatment of TB,HIV and Malaria leading to lack of funds to address the lifestyle diseases from the local and international perceptions.
In reference to this; we also have very few medics recognizing obesity as a disease and worse still is the rising prevalence in lifestyle diseases among the medics themselves,Key Govt officials and professional,institutional heads etc
In this part of the world obesity is still recognized as wellness and a sign of richness and wealthiness.
Nutritionists Without Borders was conceived in Kenya to address the rising prevalence of chronic lifestlyle diseases using prevention modalities of healthy eating and increasing physical activities since most of the local/INGO nutrition programmes are focused on reducing and preventing Protein Energy Malnutrition (kwarshiokor and marasmus).As the vision bearer,i felt that we can do so much in togetherness and that has really made us achieve much.Currently we have 20 nutritionists,10 dieticians,3 clinicians and 2 psychologist and 2 social-workers on board.
we have been doing a lot of media and community campaigns,screening and wellness programmes and we hope to move up gradually until we be heard.Its not easy but we are trying.In regards to the guidelines,yes we do have them though little implementation at the health institutions.lifestyle preventative programs directly to NGO's and other institutions if we have to reduce this rising prevalence and i emphasis on teamwork.
Maybe other countries should borrow what NWB is doing and replicate it in their settings

Regards,
Anastacia W Kariuki
Consultant Nutritionist/dietitian
Director-Nutritionists Without Borders

10 September, 2010 | Dr.Priyanka | Reply

Dr.Priyanka Really true ,its applies to all the developing countries.The Asian Indian population represents a large population within which many complex-trait disorders are found at a high frequency. The high prevalence of endogamy and relatively low admixture present in this population distinguishes it from most other populations presently used in genetic studies as it represents a distinct genetic background that is largely unaffected by outside admixture. In some cases, such as coronary artery disease, Asian Indians exhibit unique phenotypic characteristics that distinguish them from the other populations, suggesting that unique causative factors underlie this and possibly other related diseases. Therefore, it is and absolute must to understand the lifestyle and nutrition transition among these populations. Not only have the people become more prey to degenerative diseases, but also the prevalence rates of these diseases tend to exceed those in developed countries. Thus, when populations in developing countries become prone to degenerative diseases the increase in susceptibility is uneven and does not necessarily parallel an increase in prosperity

31 August, 2010 | Sushma | Reply

Sushma We need a Dietetic council like the IMC that will govern the activities of all the practicing dietitians. That council should give recognition to those dietitians who undergo the under grad the post grad courses to study dietetics and nutrition and not give license to practice for certificate courses and jiffy diplomas.

27 August, 2010 | Smriti Chawla | Reply

Smriti Chawla Dear Ms Mrinal Jhangiani I read your reply to Dr Prakash, is there no regulation body like the MEDICAL COUNCIL for Dietitians? I was told there is an organisation called IDA can they not take appropriate action?

27 August, 2010 | Mrinal | Reply

Mrinal Hi Smriti,

I am glad you brought this up as it enables me to plainly speak what everyone in the Dietetic industry knows but chooses to look the other way because it may ruffle feathers, or is politically incorrect.

There are several bodies in India that could and should speak up and take measures to ensure quality of care, patient safety and whether acceptable guidelines that are taught by esteemed Indian Nutrition programs and mandated by the government are followed and enforced.

The last time I looked none of the bodies you mention, nor the Indian authorities have ever spoken up about the quackery that is going on by a small but growing group in the dietetic field. The Universities that have produced some brilliant dietitians have allowed a handful of individuals to get away with opening their own programs and so called credible courses that are supposedly training the next generation of dietitians! These groups follow and make their own guidelines and no one utters a peep.

Its a sad day that we Indians accept this level of hijacking of a valuable industry that is so desperately needed by our large population facing epidemic levels of chronic lifestyle diseases.

For example, I could get a license to practice nutrition in a few months - put the certificate up in an office in a mahogany frame and claim to be a qualified dietitian. No representative from any institution, Federal body or dietetic organization will bother to knock questioningly on my door.

Till date, has anyone been prosecuted in India for behavior that is ruining the reputation of hard working and genuinely caring dietitians.

The dietetic industry must speak up and start cleaning up shop in India by mandating and enforcing guidelines that will protect the patient and their own reputation.

21 August, 2010 | Kanika Jain | Reply

Kanika Jain More than uniform nutrition guidelines, it is important to bring dietitians, doctors and other health care professionals along with local government together, so that can work hand in hand to tackle this lifestyle epidemic rather than putting individual efforts.

Public health authorities world over have nutrition guidelines but what is of more concern is its implementation. Even best of plans fail if they are not implemented properly. In my personal opinion, health care authorities should focus on how things are going at grass root level i.e. people, who need to be educated about risks of chronic lifestyle diseases and how they can prevent the same. They should first review whether people for whom guidelines are being framed are able to understand and implement those or not? Just framing guidelines after guidelines will not be of much help.

21 August, 2010 | Vijayalakshmi | Reply

Vijayalakshmi I personally think The Government bodies should consciously review the guidelines as stated by WHO and work on similar lines for the country. More important it should periodically review the health scene and probably refresh or fine tune the guidelines. It could be screening for a new health problem, it could be revision of the old, whatever. The whole thing must be constantly updated both National and WHO (country wise) sites for everyone who is interested to know more and act accordingly. A whole lot of the people in our country are clueless about any kind of screening or preventive measures required for good health, as there is paucity of information, unless there is an epidemic. Can we dietitians get together and bring about a change?

21 August, 2010 | Sangeetha Narayana Swamy | Reply

Sangeetha Narayana Swamy There should also be a movement that should be started by the dietitians in their respective regions that should act as a leading hand in combating the lifestyle diseases. Dietitians should come out of the four walls and plan Nutrition week, were they should involve all the dietitians in street plays, puppet shows, use flash cards, story telling etc to educate the illiterate class especially in developing countries. The local government also should join hands in this fight against the lifestyle diseases.

21 August, 2010 | Prakash Gupta | Reply

Prakash Gupta Well I am Dr Prakash a practising GP.Over the years we are talking of- ban smoking and go easy on alcohol, exercise at least 40-45 mts a day and sleep well.You dietitians are talking about balanced diet, high in fibre, low in fat, sodium and cholesterol. Avoid processed food, junk food and aerated drinks.Ultimately the person in question has to comply.We have to individualise the minor changes. So what guidelines can we issue or suggest? Anyway NV I am happy you at least are working on issues, for betterment of the people.

21 August, 2010 | Mrinal Jhangiani | Reply

Mrinal Jhangiani Dear Dr. Prakash,
Thank you for your comment.

You are right on with regards to following uniform health guidelines for lifestyle changes globally.

As certain basic preventive health guidelines have been set by esteemed agencies such as the CDC and WHO, we do recommend them to our clients at all times.

However, with regards to Nutrition there are no 'enforceable' guidelines that dietitians must follow outside the US & UK.

We are trying to address and bring attention to the indiscriminate use of unregulated programs being promoted for the sole purpose of profit with no consideration of the patients health needs or safety.

We genuinely value your input and would appreciate your continuing participation in this dialogue.

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India Anjali Dange [India]
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India Priyanka Rastogi [India]
India Shiny Chandran, MSc [India]
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Singapore Soh Wan Keem [Singapore]
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