1. SOUND BITE NUTRITION
Navigating nutrition news and providing nutrition
support for your patients and their families

2. Body size lies
• Interpreting
– Growth charts
– Body weight
– BMI

3. GROWTH CHARTS:
Breast fed fast growers picked up on both charts
0
1
2
3
4
5
6
Series 1
Series 2
Series 3
CDC WHO

4. Growth Charts: Breastfed Babies
CDC – boys 0-36 mos WHO – boys 0-24 mos
50 %
50 %

5. Body Weight
•The scale cannot
distinguish
between lean
body mass and
body fat
•Fitness trumps
weight every time

6. BMI is a poor surrogate measure of adiposity
• Compared w/ dual energy x-ray
absorptiometry, excessive body fat
was found in
77% of children w/ BMI > 95th %
20% of children w/ BMI between
85-94th %
50% of children -―moderate‖ adiposity
30% of children - ―normal‖ body fat stores
Freedman, et al. Classification of Body Fatness by Body Mass Index–for-Age
Categories Among Children Arch Pediatr Adolesc Med. 2009;163(9):805-811.

7. Body weight challenges in families
Can we crack the code?
• Obesity is related to environment
– increasing ease of access to high-energy palatable food
– diminishing requirement for physical activity
• Obesity linked to genetics
– 40-75% heritable
– Severe defects in single genes impact appetite via central
control mechanisms (gut, brain, adipose tissue)
• Hunger
• Satiety
• Hedonic effects of food
O’Rahilly & Farooqi. Human Obesity: A Heritable Neurobehavioral Disorder That is
Highly Sensitive to Environmental Conditions Diabetes, Vol. 57, November 2008

8. Energy Balance is a Physiologically
Controlled Process
• PRO
– a more enlightened attitude
toward people with obesity
with a consequent reduction in
their experience of social and
economic discrimination
– greater opportunity to do good
as we focus on individually
targeted approaches to the
treatment and prevention of
obesity. promote health at
every size

9. Energy Balance is a Physiologically
Controlled Process
• CON: Unpopular position
– Challenges current notions of self determination, discipline
and self regulation

10. Shift the focus away from body size
• Focus on metabolic health
• Spotlight true biomarkers
of health and/or disease
• Avoid risk distortion
• Allow clinicians to
effectively address
behavior linked with
unhealthy lifestyle
• Minimizes stigma and
shame

11. Disordered Eating
• Not always a primary issue with body weight, body
image
• Common and novel antecedents
– Sensory integration
– Rigid thinking, fixed mind set (ASD, ADHD, Obs/Comp
Disorders)
– Insulin resistance
– Other neurobiological disorders
• ? MC4R deficiency
• Early intervention is key
B.Y. Modugno, Scan’s PULSE, vol. 28, No. 1. Winter, 2009.

12. Saturated fat, cholesterol and
cardiovascular risk: What is the link?
•Key 1953
data, (amended)
•Studies did not
discriminate
between naturally
occurring SFA and
trans fat

13. Saturated fat, cholesterol and
cardiovascular risk: What is the link?
2009 - Heart and
Stroke Foundation
of Canada
-funding by Beef
producers, dairy
farmers of Canada
Andrew Mente, Lawrence de Koning, Harry S. Shannon, Sonia S.
Anand, MD, PhD, FRCPC. Arch Intern Med. 2009;169(7):659-669

14. The Association of Saturated Fat with
Cardiovascular Disease
Siri-Tarino, Sun, Hu, and Krauss. Am J Clin Nutr. 2010 March; 91(3): 535–546.
“A meta-analysis of prospective epidemiologic studies
showed that there is no significant evidence for
concluding that dietary saturated fat is associated with
an increased risk of CHD or CVD.”

15. If breast milk were packaged

16. Fig 2 Dose-response analyses of egg consumption and risk of coronary heart disease.
Rong Y et al. BMJ 2013;346:bmj.e8539
©2013 by British Medical Journal Publishing Group

17. Fat and Inflammation:
What is the role of fatty acid balance?
Fatty
Acids
SFA
LCSF
Palmitic
Stearic
Myristic
MCFA
Lauric
SCFA
Butyric
Valeric
MUFA
Oleic
Palmitoleic
PUFA
Omega 3
Omega
6
Omega 9

18. Fatty Acid Ratio in Foods
• Western diets are deficient in omega-3 fatty acids w/
excessive amounts of omega-6 fatty acids1
• A lower ratio of omega-6/omega-3 fatty acids linked
to reduced risk of many chronic diseases of high
prevalence in Western societies1
• The optimal dose or ratio of omega-6/omega-3
varies from 1/1 to 4/1 2
1. A.P Simopoulos. Biomedicine & Pharmacotherapy. Volume 56, Issue 8, October
2002, Pages 365–379;
2. A.P. Simopoulos. Food Reviews International. Vol. 20, No. 1, pp. 77–90, 2004

19. Fatty Acid Ratio in Foods
• Both omega-6 and omega-
3 fatty acids are healthy
• The omega-3 to omega-6
ratio is basically the “good
divided by the good,” so it
is of no value in evaluating
diet quality or predicting
disease.
Dr. Frank Sacks. Professor of Cardiovascular Disease Prevention, Department of
Nutrition, Harvard School of Public Health.

20. •Fats in the
conventional
American diet
•1909-1999
Am J Clin Nutr. 2011
May; 93(5): 950–962

21. Omega three intake
•Fats in the
conventional
American diet
•1909-1999
Am J Clin Nutr. 2011 May; 93(5): 950–962

22. ω 3, ω 6 Fatty Acids (mg)
0
500
1000
1500
2000
2500
3000
Salmon WC Farmed salmon
Omega 6 Omega 3
0
5
10
15
20
25
30
35
40
45
Omega 6
Omega 3
MILK

23. Change in FA Content of Beef In CAFOs

24. Beef

25. Food Sources of ω 6, ω 3 Fatty Acids
0
0.5
1
1.5
2
2.5
Butter 1909 Butter T Butter C
Linoleic FA (18:2)
Alpha Linolenic FA (18:3)
Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962
Modern Nutrition in Health and Disease, Ed 15. c 2006

26. Food Sources of ω 6, ω 3 Fatty Acids
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Pork 1909 Pork T Pork C
Linoleic FA (18:2) Alpha Linolenic FA (18:3)
Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962
Modern Nutrition in Health and Disease, Ed 15. c 2006

27. Food Sources of ω 6, ω 3 Fatty Acids
0
0.5
1
1.5
2
2.5
3
Chicken 1909 Chicken T Chicken C
Linoleic FA (18:2)
Alpha Linolenic FA (18:3)
Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962
Modern Nutrition in Health and Disease, Ed 15. c 2006

28. Food Sources of ω 6, ω 3 Fatty Acids
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Egg 1909 Egg T Egg C
Linoleic FA (18:2)
Alpha Linoleic FA (18:3)
Blasbalg, et al. AJCN. 2011 May; 93(5): 950-962
Modern Nutrition in Health and Disease, Ed 15. c 2006

29. Is eating more salmon (fish) the answer?
•Cost
•Wild Caught: $ 9.99-23.99/pound
•Farmed salmon: $ 7.99-8.99/ pound
•Sustainability
•It generally takes three pounds of wild fish to
grow one pound of farmed salmon
•Most salmon farmed in ocean net pens get an
"Avoid" ranking
Health Alert
•Environmental Defense Fund has issued a
health advisory for farmed salmon due to high
levels of PCBs.
http://www.montereybayaquarium.org/cr/SeafoodWatch/web/sfw_factsheet
.aspx?gid=49

30. Hooked: Sugar, sweets, & artificial sweeteners
• Food is not ordinarily like a substance of abuse, but
intermittent bingeing and deprivation changes that.
• Sweet taste elicits release of dopamine in the nucleus
acumbens
• Whether or not it is a good idea to call this a “food addiction”
in people is both a scientific and societal question that has yet
to be answered
Avena, Rada and Hoebel. Neurosci Biobehav Rev. 2008; 32(1): 20–39.

31. Candy Consumers (n = 3,458)
vs. Non-Consumers (n=7,724)
0
10
20
30
40
50
60
70
80
Weight (kg) BMI Waist Circ. (cm)
T. Candy -Cons
T. Candy- NC
Choc-Cons.
Choc-NC
Sugar-Cons
Sugar-NC
http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675

32. Candy Consumers (n = 3,458)
vs. Non-Consumers (n=7,724)
1800
1900
2000
2100
2200
2300
2400
Calories
T. Candy -Cons
T. Candy- NC
Choc-Cons.
Choc-NC
Sugar-Cons
Sugar-NC
http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675

33. Factors Influencing a Sweet Tooth
• Biochemical
– Glucose tolerance
– Hyperinsulinemia
– Insulin resistance
– Leptin resistance
• Microbial
• Neurological/Behavioral
– Dopamine
– Serotonin
• Sensory
– Mouthfeel
– Texture
• Behavioral
– Token economy
• Familial
• Economic
– Subsidized food supply
• Environmental

34. Containing a Sweet Tooth
• Balanced meals
– Adequate protein
– Emphasize whole plant foods with rich fiber content
– Enough healthy fats
• Plan for treats
– Discreet, intermittent
• Emphasis on assessing hunger & satiety
• Cultivate effective self regulation, resilience

35. The Salt Debate
http://www.oxfordjournals.org/our_journals/ajh/iom_sodium_report_comment
aries.html
• Oct 2013 Am Journal of
Hypertension—6 articles
• Experts are unclear exactly
how much sodium is ideal for
good health.
• There is likely a middle
ground, but the amount
cannot yet be pinpointed.

36. The Salt Debate
Where do you begin?
 Purchase more whole foods
 More fresh/frozen produce
 Less prepared foods
 Modest refined starch, sugars
 Salt for full flavor, not salty
 Choose carefully when eating
away from home
Mattes, RD, Donnelly, D. Relative contributions of dietary sodium sources.
Journal of the American College of Nutrition. 1991 Aug;10(4):383-393.

37. What are we buying in the supermarket?

38. Saving the planet:
Meatless Mondays, vegetarian and vegan diets
Polyface Farms, Swoopes, VA

39. Saving the planet:
Meatless Mondays, vegetarian and vegan diets
• Biodynamic farming drives a
rich soil ecology
• Plants take nutrients from the
soil; Animal manure combined
with composted plant matter
contribute needed nutrients
• Waste in the conventional
model is considered a resource
in the bio-dynamic model.
http://muchmorethanfood.com/?s=poly
face+farm
Polyface Farm relies on hay feed
for a mere 40 days of the year

40. Paleo and High Protein diets
What's the harm?

41. What else may be problematic in
highly processed food?
• The liver is the primary
metabolic clearinghouse for
4 specific foodstuffs that
have been associated with
the development of
metabolic syndrome
– trans-fats
– branched-chain amino acids
– ethanol
– fructose
Bremer, Mietus-Snyder , & Lustig.
Pediatrics. 2012 March; 129(3): 557–
570.

42. Paleo and High Protein diets
What's the harm?
Circulating concentrations
of branched-chain amino
acids (BCAAs) can affect
carbohydrate metabolism in
skeletal muscle, and
therefore may alter insulin
sensitivity
Newgard, et al. A Branched-Chain Amino Acid-Related Metabolic Signature that
Differentiates Obese and Lean Humans and Contributes to Insulin Resistance. Cell
Metabolism, 9. 311-326. April 8, 2009.

43. Amino Acids Comparison
(mg per 100 calories)
0
50
100
150
200
250
300
Human milk
Enfamil NB
Enfamil PI
Isomil*

44. Getting kids to eat:
How to feed super tasters and picky eaters
• Food preferences are shaped by
a combination of genetic and
environmental factors
• Over-control, restriction, pressure
to eat, and a promise of rewards
have negative effects on
children's food acceptance
• Children model themselves on
their parents’ eating
behaviors, lifestyles, eating-related
attitudes, and dissatisfaction
regarding body image

45. NEOPHOBIA
Genetic Traits
Environmental
Factors
Behavioral
Factors
Parents
Siblings
•In utero
•Breastfeeding
•Exposure
•Modeling
Anxiety
Emotionality
British Journal of Nutrition (2008), 99, Suppl. 1, S15–S21

46. Consumption patterns of infants and toddlers consuming foods
at least once a day
0
10
20
30
40
50
60
70
6-8.9 mo
9-11.9 mo
12-14.9 mo
15-17.9 mo
18-24 mo
Feeding Infants and Toddlers Study (FITS) ADAJ 2010

47. NEOPHOBIA

48. Supertasters
• 25 % of population (35% women; 15%
men)
– 25% non tasters
– 50% medium tasters
• Far more sensitive to odors, flavors of
food
• Other characteristics may also be more
intensely experiences
– Texture
– Temperature
– Color
– Mouth feel
– Size, shape
HYPOSENSITIVE HYPERSENSITIVE

49. Incidence of Food Allergies in the US
Amy M. Branum and Susan L. Lukacs , Pedriatrics. Food Allergy Among
Children in the United States. Nov 16, 2009 DOI: 10.1542/peds.2009-1210

50. Grains, gluten free and gut health:
Why so many food sensitivities today?
• Basic dietary sources
– Barley (malt, malt flavoring and malt vinegar are usually
made from barley)
– Rye
– Triticale (a cross between wheat and rye)
– Wheat

51. Grains, gluten free and gut health:
Typical food sources of gluten
Beer Breads Cakes & pies Candies
Cereals Cookies and crackers Croutons
French fries Gravies Imitation meat or seafood
Matzo Pastas Processed luncheon meats
Salad dressings Sauces, including soy sauce
Self-basting poultry Soups and soup bases
Dry roasted & honey roasted nuts and seeds Vegetables in sauce
Seasoned rice mixes Seasoned snack foods, such as potato & tortilla chips

52. Grains, gluten free and gut health:
300 million pounds of gluten added to processed food per year
MSG Smoke flavors Glazes
Textured vegetable protein Artificial flavors Ice cream, frozen yogurt
Hydrolyzed vegetable protein Natural colors Instant teas, coffees
Hydrogenated starch hydrozylate Artificial colors Mayonnaise
Hydroxypropylated starch Caramel coloring & flavoring Mustard
Pregelatinized starch Soy sauce Frying oil
Vegetable gum Miso Seasoned poultry/meat
Vegetable protein Boullion or stock cubes Sour cream
Extenders and binders Cheese foods/spreads Dry & honey roasted nuts
Maltodextrin Dextrin Maltose
Baking powder Natural flavors Chocolate

53. Autism spectrum disorders, ADHD, and related conditions:
How diet can make a difference
• EATING FOR AUTISM—Elizabeth Strickland, MS, RD
• Step 1: Transition Your Child to a
Healthy Diet
• Step 2: Make Sure Your Child is
Getting Enough Basic Nutrients

54. Autism spectrum disorders, ADHD, and related conditions:
How diet can make a difference
Step 3: Choose a Daily Multivitamin and Mineral
Supplement for Your Child
Step 4: Increase Your Child’s Omega-3 Fatty Acid
Intake
Step 5: Resolve Your Child’s Feeding Problem
Step 6: Heal Your Child’s Gut
Step 7: Identify and Treat Food Allergies
Step 8: Consider Putting Your Child on a Special
Elimination Diet
Step 9: Try High Dose Vitamin B6 with Magnesium
Step 10: Explore Additional Supplements

55. Body Burden: reducing chemical contamination
especially in utero and for young children

56. Food System–Related Environmental Chemicals Detectable In
Pregnant Women In The United States, 2003–04.
Sutton P et al. Health Aff 2011;30:888-897
©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

57. Body Burden: reducing chemical contamination
especially in utero and for young children
J Clin Endocrinol Metab. 2011 Mar;96(3):E480-4. doi: 10.1210/jc.2010-1658. Epub
2010 Dec 30.

58. Body Burden: reducing chemical contamination
especially in utero and for young children
http://www.epa.gov/oppfead1/Publications/pest-impact-hsstaff.pdf

59. The Cost of Buying Conventional vs. Organic
Foods Using a Sample Market Basket
$0.00
$20.00
$40.00
$60.00
$80.00
$100.00
$120.00
$140.00
Market Basket Cost
Conv-Ralph's
Conv-WF
Org WF

60. USDA Food Costs for Feeding Children
Allocated by Individual Food Groups 2013
FOOD Δ USDA
Guidelines
% Costs
2-3 y/o
% Costs
4-5 y/o
% Costs
6-8 y/o
Grain
<13> 5 8 8
Vegetables
52 24 15 19
Fruit
57 17 37 32
Milk/ Milk
Products
54 43 30 29
Meat and
Beans
<49> 6 7 9
Other (fats,
sweets)
<54> 5 3 3

61. The cost of food

62. How Much Does 100 Calories Cost?
0
10
20
30
40
50
60
70
80
90
100 Calories
Soda
Bread
Potato
chips
Cookies
Licorice
Orange
Apple
Carrots
0
0.5
1
1.5
2
2.5
100 Calories
Organic
Milk
Organic
Apple
GF Beef
WC Salmon
Cost in cents Cost in $$