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 policies include implementing road designs 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 Germany 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 that 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 Handy and others' 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 more 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 transit, walk, or bicycle than in other areas and to weigh less and be less likely to suffer from hypertension Ewing, Schieber, and Zegeer ; Lopez ; Saelens, Sallis, and Frank 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 In contrast, urban sprawl has been linked to decreases in mental health and social capital Frumkin as well as anger and frustration over long commutes Surface Transportation Policy Project Sprawl adversely affects the elderly in particular because 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 box 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 box Promoting Physical Activity in Brazil.
People's diets can be enhanced by improving the food supply. 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 of 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 change their processes. For example, in , the U. Food and Drug Administration announced that food manufacturers had to include trans fatty acid content on the standard food label. Following imposition of this requirement, several large food companies said that they would reduce or eliminate trans fats, and many more are planning to do so U.
Food and Drug Administration 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 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 of 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 in 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 B vitamins. Since , 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 Where intakes 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; therefore, 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 from 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 that targeted at children. For example, in the United States, 46 percent of adults surveyed supported restrictions on advertising to children Blendon 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 are likely to be most effective when they are multi-faceted and coordinated and when they are developed with the active involvement of individuals and organizations within communities Puska and others 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.
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 box The Coronary Risk Factor Study in South Africa Rossouw and others 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 and , the rate of obesity declined by 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 of smoking see chapter Policies that could influence diet and physical activity deserve careful consideration because they are rarely neutral and often support unhealthy behaviors.
Consider the following examples:. After Poland's transition to a democratic government in the early s, the government removed large subsidies for butter and lard, and consumption of nonhydrogenated vegetable fat increased rapidly Zatonski, more Primary targets for reducing lifestyle diseases include changing the fat composition of the diet, limiting sodium intake, and engaging in regular physical activity.
Using 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 in moderate physical activity by three to five 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. 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 We could not use the model for saturated fat to estimate the effects of replacing trans fat with polyunsaturated fat because only a small part of the benefit is attributable to reducing LDL cholesterol F.
Hu and Willett 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 probably fatal cardiac arrhythmias.
In calculations that are based only on the adverse effects on LDL and HDL, replacing 2 percent of the energy from trans fat with polyunsaturated fat was estimated to reduce CAD by 7 to 8 percent Grundy ; Willett and Ascherio Epidemiological studies, which include the contributions of the additional causal pathways, suggest a much greater reduction, from about 25 to 40 percent F.
Hu and others ; Oomen and others 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 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. Food and Drug Administration 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 in 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 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. 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 could the costs of the education campaign. 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 augmented with a public education campaign only if needed to support the legislated change.
At lower implementation costs, the intervention is highly cost-effective, even with half the assumed effect on blood pressure. 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. If we project the economic benefits to the entire U.
A series of U. Colditz estimates that obesity is responsible for 7 percent of all U. Indirect costs associated with obesity and inactivity account for another 5 percent of health care costs.
Pronk and others 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 and community-based interventions appear to be cost-effective if 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 policy are often complex and 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. 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 interventions for control of smoking are discussed elsewhere :. Implementation of the recommended policies to promote health and well-being is often not straightforward because of opposition by powerful and well-funded political and economic forces, such as those involved in the tobacco, automobile, food, and oil industries Nestle The solutions will depend on a country's specific political landscape.
However, experiences in many countries indicate that alliances of public interest 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 free 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 the developing countries.
Turn recording back on. National Center for Biotechnology Information , U. Search term. Box Chronic Disease Prevention In this section, we briefly review dietary and lifestyle changes that reduce the incidence of chronic disease. Recommended Lifestyle Changes Specific changes in diet and lifestyle and likely benefits are summarized in table Avoid Tobacco Use Avoidance of smoking by preventing initiation or by cessation for those who already smoke is the single most important way to prevent CVD and cancer chapter Maintain a Healthy Weight Obesity is increasing rapidly worldwide chapter Maintain Daily Physical Activity and Limit Television Watching 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 Eat a Healthy Diet Medical experts have long recognized the effects of diet on the risk of CVD, 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.
Replace saturated and trans fats with unsaturated fats, including sources of omega-3 fatty acids. Replacing saturated fats with unsaturated fats will reduce the risk of CAD F. Also, polyunsaturated fats including the long-chain omega-3 fish oils and probably alpha-linoleic acid, the primary plant omega-3 fatty acid can prevent ventricular arrhythmias and thereby reduce fatal CAD.
In a case-control study in Costa Rica, where fish intake was extremely low, the risk of myocardial infarction was 80 percent lower in those with the highest alpha-linoleic acid intake Baylin and others Intakes of omega-3 fatty acids are suboptimal in many populations, particularly if fish intake is low and the primary oils consumed are low in omega-3 fatty acids for example, partially hydrogenated soybean, corn, sunflower, or palm oil.
These findings have major implications, because changes in the type of oil used for food preparation are often quite feasible and not expensive. Ensure generous consumption of fruits and vegetables and adequate folic acid intake. Strong evidence indicates that high intakes of fruits and vegetables will reduce the risk of CAD and stroke Conlin Some of this benefit is mediated by higher intakes of potassium, but folic acid probably also plays a role F.
Supplementation with folic acid reduces the risk of neural tube defect pregnancies. Substantial evidence also suggests that low folic acid intake is associated with greater risk of colon—and possibly breast—cancer and that use of multiple vitamins containing folic acid reduces the risk of these cancers Giovannucci Findings relating folic acid intake to CVD and some cancers have major implications for many parts of the developing world.
In many areas, consumption of fruits and vegetables is low. For example, in northern China, approximately half the adult population is deficient in folic acid Hao and others Consume cereal products in their whole-grain, high-fiber form.
Consuming grains in a whole-grain, high-fiber form has double benefits. First, consumption of fiber from cereal products has consistently been associated with lower risks of CAD and type 2 diabetes F. Hu, van Dam, and Liu ; F.
Hu and Willett , which may be because of both the fiber itself and the vitamins and minerals naturally present in whole grains. High consumption of refined starches exacerbates the metabolic syndrome and is associated with higher risks of CAD F. Hu and Willett and type 2 diabetes F. Second, higher consumption of dietary fiber also appears to facilitate weight control Swinburn and others and helps prevent constipation.
Limit consumption of sugar and sugar-based beverages. Sugar free sugars refined from sugarcane or sugar beets and high-fructose corn sweeteners has no nutritional value except for calories and, thus, has negative health implications for those at risk of overweight. Furthermore, sugar contributes to the dietary glycemic load, which exacerbates the metabolic syndrome and is related to the risk of diabetes and CAD F.
Hu and Willett ; Schulze and others WHO has suggested an upper limit of 10 percent of energy from sugar, but lower intakes are usually desirable because of the adverse metabolic effects and empty calories.
Limit excessive caloric intake from any source. Given the importance of obesity and overweight in the causation of many chronic diseases, avoiding excessive consumption of energy from any source is fundamentally important. Because calories consumed as beverages are less well-regulated than calories from solid food, limiting the consumption of sugar-sweetened beverages is particularly important.
Limit sodium intake. The principle justification for limiting sodium is its effect on blood pressure, a major risk factor for stroke and coronary disease chapter WHO has suggested an upper limit of 1. Potential of Dietary and Lifestyle Factors to Prevent Chronic Diseases Several lines of evidence indicate that realistic modifications of diet and lifestyle can prevent most CAD, stroke, diabetes, colon cancer, and smoking-related cancers. Interventions 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.
Educational Interventions 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. School-based Programs School-based programs include the roles of nutrition and physical activity in maintaining physical and mental health box Worksite Interventions 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 by Health Care Providers 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.
Find a lover, a cuddly kitten or puppy or simply take a stuffed toy to bed, but ditch that phone when you hit the sack! Till date the quest for an AIDs cure has been like plucking petals - 'he loves me, he loves me not'! But recent research has been encouraging and a cure may not be far at hand. The grass is always greener on the other side especially if you suffer from osteoarthritis. But adding these healthy greens to your diet could make it a lot greener for you too!
Your child may be growing up but he still needs to sleep like a baby! Do you know how much sleep your child needs? You could be 50 and fatigued or flipping that fedora and partying. Look for love, find a hobby! Fifty just got better than 20, 30, and 40! To get the best diet tips to support your bodyforming goal — whether your are looking to lose weight, burn body fat or smooth out bumps and lumps — click on one of the following links:.
The role of diet in the development of cancer has been in the focus of many scientists since the s. In Western countries such as the United States and the United Kingdom, about a third of all cancers have been estimated to be directly or indirectly linked to dietary factors. To learn about dietary factors that can help reduce your risk of developing a specific type of cancer, click on one of links below:. When it comes to healthy hair, skin, and nails, it is not just what you put on your locks, cheeks and nails that matters — it is also what you put in your mouth.
Select one of the categories below to get the best diet tips for supporting your beauty goals:. Select one of the resources below to access detailed information on common health problems that affect women's health, and on how these problems can be tackled with appropriate nutrition:.
The health of your digestive system is closely tied to your diet. To learn how to prevent common digestive problems and diseases through a nutritional approach, choose the diet plan the fits your goals best from the following list:.
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