Dietary Analysis and Reflection

Diet Analysis Summary Final
MyPlate.gov was very informative. It was nice to start the class out with a website that was very detailed but still interesting so you weren’t overwhelmed with the vast amount of information. It was easy to maneuver and find the information you needed. It is a very useful tool for an individual to use so they can learn the proper portions of a healthy diet. The individual plan you can receive from a licensed dietitian on the Super Tracker portion of MyPlate.gov is a wonderful feature. It can keep track and inform you if you have reached your goal for each food group, how many calories you’ve eaten per day, and the target amount of physical activity you should be doing per week. Each food group section under the MyPlan portion of the SuperTracker gives you the exact amount of ounces needed for your personal calorie goal. It breaks down how much an ounce is in popular foods, for example, 1 ounce of bread is 1 regular slice and 1 ounce of brown rice is ½ cup. The individualized sample meal plans take the guess work out of planning your weekly meals. It is designed to meet your individual nutritional needs and your personal calorie goals. Unfortunately, I haven’t used it since it was a part of the assignment many weeks ago. Since my diet isn’t well balanced and I need to add healthier selections off all the food groups into my diet MyPlate.gov is a great place for me to start. It can help me do some weekly meal planning since that is a huge weakness of mine. I can make healthier choices for myself and my family with the help of MyPlate.gov.

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Carbohydrates are a huge weakness for me as I love sugary candies, breads, pastas, chips, and juices. Each one of my weaknesses has an excess amount of sugars. When I eat too many sugars my digestive tract delivers glucose to my bloodstream and that carries the glucose to my liver and body cells. However, my body cells do not need any additional glucose so it is stored as glycogen in the muscle and liver. Once those stores are full the body cells go from burning fat to burning the excess glucose which leaves excess fat floating in my bloodstream until it’s picked up by fatty tissues and stored. Unfortunately, the fatty tissues have an unlimited capacity to store fat. An excess of blood glucose can lead to type II diabetes which can lead to circulation problems and nerve damage. Low blood pressure and nerve damage can lead to loss of blood flow to the kidneys which damages them, increased likelihood of infections, and possible loss of limbs due to gangrene and amputation. How I can prevent type II diabetes is to reach a healthy body weight of 120 pounds. To do that I need to eat healthy meals that are moderate in calories low in saturated fat, high in vegetables, fruit, legumes, chicken, fish, and whole grains. I need to be physically active, and limit my alcohol intake. The best way for me to cut out the excess sugars in my diet is to switch the sugary candies and chips with fruit and vegetables. Change the breads and pastas I eat to 100% whole grain bread. Stop drinking fruit juices and replace them with water. Doing all this can also increase my soluble and insoluble fiber intake which can help reduce my risk if type II diabetes, alleviate or prevent constipation, and lower my risk for digestive tract cancers. The changes I have made this semester about my carbohydrate consumption are; I have replaced my breads and pastas with whole wheat breads and pastas. I’ve increased the amount of vegetables and fruits I’m eating daily. Unfortunately, I haven’t decreased the amount of chips and sugary candies. It has been and still is a very stressful time for me and when I’m stressed I eat and I prefer to eat chips and candies.
I have a great weakness for eating foods that are high in cholesterol and fat. I’ve enjoyed eating items like shrimp Alfredo and hamburgers and French fries. I have an elevated risk of developing heart disease because I am overweight, I eat high cholesterol and fatty foods, and I am physically inactive. The recommended daily amounts of fat for someone like Me Is 37 to 66 grams; whereas my average daily intake was 75grams. The recommended daily amount of cholesterol should be less than 300mg; whereas my average daily intake was 367mg. If I continue to eat this way I will develop heart issues like hypertension, atherosclerosis which can lead to coronary heart disease or stroke; I am also at high risk for developing cancer. I can lower my blood cholesterol by focusing on low cholesterol foods, low saturated fat foods, and Trans fat free foods like whole grains, fruits, soy, vegetables, fatty fish, oats, and beans. I need to become more physically active. Even doing simple things can impact my physical activity level like using the stairs instead of the elevator or I can wash my car instead of taking it to a car wash. One of the best changes I can make to improve my health is to start eating fatty fishes like sea bass, herring, trout, and salmon. These fish are an excellent source of omega-3. Omega-3’s can lower total cholesterol and LDL and can increase HDL. It can also lower the rates of some cancers by suppressing inflammation. Additional foods I can eat to fight cancer are crucifer vegetables like cabbage, cauliflower, and kale which boosts an enzyme in the body that fights cancer. All berries have a phytochemical that can slow down the growth of pre-malignant cells. Tomatoes have lycopene which can stop the growth of endometrial cancer. This semester I have decreased my red meat intake and have replaced it with chicken or turkey. When I cook at home I get a 3% fat ground turkey for our meals instead of ground beef. I have also changed the hamburgers I make at home for turkey burgers or veggie burgers, and my family loves them.
My biggest weakness with proteins is animal-derived proteins; I eat eggs almost every morning for breakfast and have an animal derived protein with almost every lunch and dinner. An excess amount of protein itself is not known to contribute to heart disease, but excess amount of animal-derived protein does. They add unnecessary fat calories and saturated fat to my diet. Eating all that animal-derived protein leaves out all the other sources of protein I can consume which are much healthier like whole grains, fruit, legumes, and vegetables. Since I eat a lot of animal-derived protein I have a higher risk in being obese, it causes adult bone loss, and I have a greater risk in heart disease, diabetes, and cancer. To lower my animal-deprived protein I can eliminate the eggs in my breakfast and eat oatmeal. For lunch I can have rice and beans instead of a lunch meat sandwich. For dinner I can make a tofu stir-fry instead of a grilled chicken breast. If I change at least one of my daily meals form animal-derived protein to vegetable-derived protein I can cut down the amount of cholesterol and saturated fat I consume. This semester I haven’t changed the types of proteins we consume. What I can do that wouldn’t change our routine to much is to switch out or eggs for egg beaters. For three tablespoons, which is the same as one egg, it has zero saturated fat and cholesterol but still has 5 grams of protein which is only 1 gram less than a normal egg but so much healthier.
My diet is low in folate, vitamin C, and potassium; and it is high in sodium. A diet low in folate can lead to many problems like anemia, fatigue, headache, weakness, irritability, and mental confusion. Most adults are to have 400mcg a day of folate; my average was 186mcg per day. So I definitely need to consume more foods rich in folate like asparagus, pinto beans, and lentils. A diet low in vitamin C can lead to fatigue, joint pain, bone fragility, bruises, frequent infections, bleeding gums, and poor wound healing. Most adults are to have 75mg a day of vitamin C; my average was 49mg per day. So I definitely need to consume more foods rich in vitamin C like sweet red peppers, strawberries, and broccoli. A diet low in potassium can lead to confusion, muscle weakness, and paralysis. Most adults are to have 4700mg a day of potassium; my average was 1050mg per day. So I definitely need to consume more foods rich in potassium like lima beans, baked potato, and a banana. I can pick out symptoms that I suffer from, out of each of those deficiencies. A diet high in sodium is also very bad for my health. Over time my high sodium diet may damage the linings of my blood vessels in ways that makes hypertension more likely to develop. A high sodium diet can also lead to heart disease and stroke. Some of the foods I eat regularly that are high in sodium are chips, microwave popcorn, turkey dogs, and macaroni and cheese. All that food can easily be replaced with healthier options. The chips and popcorn can be replaced with the strawberries and sweet red peppers so I can also get the vitamin C I need. The turkey dogs and macaroni and cheese can be replaced with a baked potato and pinto beans. This semester I have been eating more fruits and vegetables so I fell like my folate, vitamin C, and potassium will be better but my sodium intake hasn’t been decreased. I’m still eating my chips and convenient food.
My diet is low on both calcium and iron. The recommended daily amount of calcium is 1000mg a day. There were days when I was just under that amount, 750mg, because I would have milk and cereal sometime during the day. However, there were some days where I would only consume 200 mg of calcium. That fluctuation and having more days where I consumed less calcium I am at risk for osteoporosis. Since calcium supplements are less effective than the calcium found in food sources I should increase my consumption of calcium rich foods like tofu, milk, and broccoli. The recommended daily amount of iron is 18mg a day. The average amount of iron I consumed was 12mg. That’s only because one day I had consumed 21mg; that’s because 12 mg came from eating a fortified cereal. Other days ranged from 2-11mg. Having an iron deficiency I have a higher risk of becoming anemic, being weak and fatigued, having headaches, and impaired immunity. The best way for me to increase my iron consumption is to eat navy and black beans, spinach, and clams. I have tried to increase my calcium intake during this semester by eating more yogurt. I’m not a big milk drinker but I like soy milk and almond milk. When we can get back into our condo I plan on making smoothies for breakfast again. I made it with tofu, soy milk, yogurt, spinach, a banana, and frozen fruit. It was delicious and full of nutrients.
According to my BMI I am considered obese our book even calls me extremely obese. I absolutely, with every fiber in my being, hate that word. That one word can just get under my skin and make me so angry. I understand I’m overweight and I need to lose all the excess pounds I’m carrying, but don’t degrade me! That word has such negative connotations that it only makes you feel even worse about yourself. Is that what that word is meant to do? Is it meant to humiliate you into losing weight? If so it doesn’t work on me, it does the exact opposite. I get so angry and defensive, but inside I’m embarrassed so I eat more and become unhappy. I already have such prejudices for being overweight that I don’t need a book to call me names. I can’t go to the grocery store and buy healthy food because I get comments from people asking if I’m on a diet and getting a “good for you for trying to be healthy”. Or if I go to the store to buy any type of junk food I always get the nasty stares or the comments of “are you sure you should be eating this”. So either way if you’re fat you can’t win. Never mind about going to the gym; if you want to find the most stuck up nasty people be an overweight person at a gym and they’ll find you. I understand that one of the best things I can do to live longer and healthier is to lose weight, but I feel like if I do that then I’m agreeing with society that I’m not good enough for them just the way I am, and I’m not ok with that.
Finding out all the information about nutrition, and my specific diet, throughout this semester has made me realize I do need to make some changes. I have come up with 5 SMART goals to accomplish during the summer. My first goal is to make my meals more balanced with healthier selections. Starting Monday I will follow the MyPlate.org guidelines by adding more vegetables, fruits, whole grains, and dairy to my diet. I will do this by adding a fruit and vegetable to each meal and snack; having some type of dairy with each meal like low-fat cheese or yogurt; and changing all my carbohydrates to 100% whole grains. I will reassess my progress in 4 weeks. My second goal is to lower my daily sodium intake by 1000mg by the end of June. I will actively look for low sodium food to replace the high sodium food I’m currently eating. Instead of having chips with my lunch Ill have carrots or celery. I will not sprinkle additional salt on to my food during meals. My average daily sodium intake is at 3600mg so by the end of June I will have it to 2600mg or less and then reassess my sodium intake. Since a lot of my protein intake is from animals I would like to change that. My third goal is by the end of June one meal each day will be vegetarian. I will do this by substituting my animal protein with plant based protein. Instead of a turkey sandwich for lunch I can make a bowl of brown rice and beans; or for breakfast I can have oatmeal. Dinner I can make a tofu stir-fry with fresh vegetables. My fourth goal is to decrease the amount of sugary candies and chips I eat. My go to food when I’m stressed, feeling sad or lonely is candies and chips. By the end of July I will be able to switch my dependence on candies and chips to exercise and eating healthier. When I’m craving a candy I’ll go and drink a glass of water and eat an apple. Instead of sitting on the couch and feeling sorry for myself I’ll get up and go for a walk. My fifth and final goal is to be more active. By the end of July I will walk for 30 min on Monday, Wednesday, and Friday, and lift weights beginning with 3 reps of 25 on Tuesday, Thursday, and Saturday. By the end of July I will reassess my physical abilities to see if I can increase my routine.
My feeling on this assignment was that it was interesting and eye opening. The only complaint I have is with the 7 paragraphs, at least for myself it wasn’t that clear on what you were wanting for each paragraph. The 4 bullet points you wanted added to each paragraph didn’t fit in with all the paragraphs. One of the bullet points asked for you to discuss your successful strategies; what if you haven’t changed any part of your diet to have any strategies. With the paragraph about MyPlate the 4 bullet points were hard to incorporate into it. I did somewhat enjoy the class; I was getting tired of every chapter telling me I was going to die of heart disease and cancer. I need to teach myself to not be so defensive about this subject and to stop thinking that trying to improve myself doesn’t mean the person who I was wasn’t good enough.
Works Cited
“ChooseMyPlate.gov.”ChooseMyPlate.gov. USDA, 2014. Web. 09 May. 2014.
“Heartorg Home Page.”Heart.org. American Heart Association, 2014. Web. 09 May. 2014.
“Learn About Cancer.”Cancer.org. American Cancer Society, 2014. Web. 09 May. 2014.
“Supertracker.”Supertracker.usda.gov. USDA, 2014. Web. 09 May. 2014.
Webb, Frances Sizer., and Eleanor Noss. Whitney.Nutrition: Concepts & Controversies. 13th ed. Belmont, CA: Wadsworth Cengage Learning, 2013. Print.
 

Examination of the Efficacy of Dietary Supplements

What has led to the popularity of dietary supplements and is their success deserved?
Surname: LU First name: YIXUAN
Introduction
The definitions of dietary supplements are varied from different countries which specify the scope of the term differently, and this essay presents a logical common definition of dietary supplements. Dietary supplements, the forms of which are usually tablets, pills, powders, capsules or liquid preparations, are oral products taken at recommended dosage in addition to normal food intake. It contains one or more kind of nutrient which is derived from food products such as vitamins, minerals and trace elements. Additionally herbs or other botanicals are included in US definition.

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The sales of dietary supplements show that the popularity of dietary supplements among all fields and all ages of people has been rising dramatically in a few decades. In the US, sales of dietary supplements in 2001 were about $17.8 billion (Nutrtion Journal. 2011), and as reported by the latest statistics, dietary supplements annual sale has increased to approximately $30 billion (MD, 2014).
In this essay, first of all, I will illustrate the reason why food supplements become so popular among general public, followed by a detailed illustration of the benefits of dietary supplements as supporting. Then some controversial issues raised by such popularity will be revealed, and the risks of taking dietary supplements are shown subsequently. In the end, I will give some suggestions to consumers when taking dietary supplements.
The popularity of food supplements
There are many factors accounting for the popularity of food supplements. Ransley et al. (2001) argue that four main driving forces cause this popularity. Firstly, the modern diet seems can hardly meet the strict requirement of health and life of people today especially in terms of nutrition, and the lack of the categories and quantities of nutrients can be supplied by taking dietary supplements. Secondly, eating dietary supplements are considered to be a remedy or precaution of aging-related diseases, which makes them quite popular among old people. Thirdly, in consideration of the increasing price of medicines and the inconvenience of seeing a doctor, taking dietary supplements directly is more attractive to consumers. Lastly, with the improvement of living standard, people are more concerned about their own health. Therefore he desirable features of food supplements can get people’s attention successfully.
The benefits of taking dietary supplements
Taking right amount of food supplements can assure an adequate dietary intake of essential nutrients. Although we can get all the vitamins and minerals we need as long as we keep a well-balanced diet every day, it is not easy to follow this good habit strictly especially among commuters and teenagers. Therefore, Webb (2006) claims that using dietary supplements, such as multivitamins and cod liver oil, usually helps ensuring the adequacy of nutritionally diet. As Walji (1995) and Mason (2001) point out, having irregular meals is quite common and this may cause nutritional deficiency. Besides, improper methods of preserving and cooking food may result in the loss of some nutrients from food, particularly those delicate and unstable vitamins, which may cause a phenomenon that people eating a lot but still undernourished (Walji, 1995). Additionally, the amount of nutritional requirements vary from person to person, even the nutrient containing in the standard diet may still be either exceed or inferior to some people. Therefore having a wholesome diet with the addition of supplements personally is a good way to ensure the correct amount of nutrients keeping our body in optimum condition. Besides, food supplements do have a powerful psychological effect on consumers. This is shown in a research that many consumers use supplements occasionally and take them only when the spirits are low or when they are stressful (Ransley, et al., 2001).
Another benefit of taking dietary supplements is the efficacy of preventing deficiency diseases (Webb, 2006; Mason, 2001). In order to cure some diseases, people may need to increase demand for a particular nutrient in certain medical conditions or other circumstances. Take vitamin D deficiency as an example, vitamin D has the function of promoting intestinal tract absorption of calcium. Webb (2006) points out that the main source of vitamin D inside body comes from exposing the skin to the ultraviolet rays in the sunshine. People who spends less than the necessary amount of time under the sunshine, seems to be more vulnerable to vitamin D deficiency. Webb (2006) also notes that the lack of vitamin D is an essential contributing factor in the development of osteoporosis among old people. Combining with the fact that the ability of converting sunlight into vitamin D in the elderly will decrease as they grow older, taking related supplements become more necessary and functional. COMA (1991) recommended that vitamin D supplements should be taken by all aged people only if they are regularly exposed to the sunlight with reasonable amount of time (Webb, 2006).
The usage of dietary supplements also contributes to avoiding other diseases or illness such as cardiovascular diseases, cancers or skin problems. Differentiating from the supplements treating nutritional deficiencies, food supplements for other diseases may have long-term positive effects on physical condition (Webb, 2006). For instance, fish oil supplement is well known for its effect on heart diseases. A conclusive study demonstrating the function of fish oil has been done by Burr et al. (1989). He tested “the effects of dietary intervention in the secondary prevention of myocardial infarction (MI)” (Burr et al. 1989, p757). The result shows a nearly 30% decrease in total mortality among the tested men who were suggested to eat oily fish (or fish oil capsules if some people did not eat fish) during the two years study (Burr et al. 1989). Although some variables may have not considered in the study, it is still a comparatively successful experiment verifying the efficacy of fish oil which is the main effective ingredient in fatty fish.
Controversial problems following with the popularity
With the growing popularity of taking food supplements, many controversial problems arise subsequently. What is the standard direction of taking dietary supplements? Are there adequate regulations of dietary supplements market especially in terms of herbs and mineral? whether dietary supplements make a worthwhile contribution to a healthy diet? All these issues point to the risks of taking dietary supplements.
The risks of taking dietary supplements
There are so many unknown risks of eating dietary supplements, one of the main risks is that it may be harmful if people taking supplements in wrong dosage. If people take over-dose of specific supplements in the diet, such behavior may trigger the food-drug interactions (Hans, et al., 2001). Both the FDA (Food and Drug Administration in the US, 2014) and Webb(2006) state that the excessive use of some supplements, such as vitamin and iron, may cause some health risks and needless effects before, during and after surgery. For example, large β-carotene supplements are known for the efficacy of preventing heart disease and cancer, but some studies show that such supplements may have counteractive. “Rapala et al. (1997) reported increased death rates from coronary heart disease in those subjects (smokers) given β-carotene supplements compared with those receiving either the placebo or vitamin E supplements” (Webb, 2006). In addition, the ‘inverse supplement hypothesis’ claims that some people who already have sufficient nutrition are more likely to taking supplements (Ransley, et al., 2001). Here is the evidence provided by the Women’s Cohort Study. In this study, one of the informants took 9g of vitamin C from supplements and an extra 90mg from another vitamin preparation. The intake of these two was more than 200 times than the RNI (Recommended Nutrient Intakes) and this is the amount without taking her dietary intake into account (SFL, et al., 1998). The above-mentioned evidence illustrates that consumers taking wrong dosage of food supplements may also be harmful.
Another risk of taking dietary supplements is the lack of informed advices. As Blendon et al. (2001) indicate that, there is a lack of connection and trust between physicians and consumers. Because consumers do not believe in the information about supplements from physicians, likewise when physicians notice some problems about dietary supplements, they do not inform the consumers. Therefore, consumers prefer to take self-meditation, such as using dietary supplements to treat their illness, which is more convenient and have private space. However, when consumers need to ensure the daily intake, they have to search sources of advice from some unidentified places, such as internet, dietary supplement shop or the media. “This approach to self-meditation will carry risks and corresponding proof is that intakes of some supplements can be toxic to health and will cause serious adverse effects such as diarrhea (vitamin C) and flushing (niacin) ” (Ransley, et al., 2001, p12).
Furthermore, many benefits of dietary supplements are still unknown and unproved, so taking dietary supplements should be very cautious. The FDA (2014) illustrates that many supplements contain active ingredients which may cause strong biological effects in the body and increase risks of health in some cases. Therefore, the behavior of some consumers, using dietary supplements instead of prescription medicines, is obvious unwise (U.S.FDA, 2014). Since dietary supplements are neither food additives nor drugs, they are in a special status which was established by the Dietary Supplement Health and Education Act (Hunrer and Trum, 1999). Obviously, it is not sensible to replacing the prescription medicines to supplements. In terms of herbs, herbal products do have some clinically proven benefits, but there are more facts illustrate its potential of containing toxic substances, especially regarding to the interaction with drugs (Halsted, 2003).
Conclusion
From what the essay has mentioned above, dietary supplement has a close relationship with our daily health. It is clear that the benefits of dietary supplement contribute to its popularity mainly. Various number of food supplements added in our daily intakes suitably enable us a nutritional-balanced diet. However the risks of taking dietary supplements are non-ignorable, which not only imply the room of the improvement of dietary supplements but also remind us necessity of taking supplements cautiously. In addition, some benefits of eating food supplements as well as the risks may be missing in this essay.
It is not objective to say the popularity is good or not directly. In my view, the increasing number of people taking dietary supplements reflects a high awareness of personal health among publics. Meanwhile eating dietary supplements wisely is also necessary.
To keep the balance of dietary supplement, several measures should be taken by the government. Such as strengthen the supervision of the production and sales of dietary supplements, establish detailed guideline of the usage of supplements and cultivate specialists in the field of food supplements. Apart from some regulations should be improved by the authorities, what we should do is be a savvy supplement user, thinking twice when purchase food supplements, reading the instructions of the supplements carefully before taking these products, finding out the relevant benefits of them in order to deepen the understanding of preparations and noticing the deficiency symptoms and following the measurement with cautious.
References
Blendon, R. J. et al., 2001. Americans’ Views on the Use and Regulation of Dietary Supplements. JAMA Internal Medicine, 26 March, pp. 805-810.
Burr, et al., 1989. EFFECTS OF CHANGES IN FAT, FISH, AND FIBRE INTAKES ON DEATH AND MYOCARDIAL REINFARCTION: DIET AND REINFARCTION TRIAL (DART). The Lancet, 2(8666), p. 757–761.
Eaglstein, W. H., 2014. What Are Dietary Supplements and Nutraceuticals?. In: The FDA for Doctors. s.l.:Springer International Publishing, pp. 25-27.
Halsted, C. H., 2003. Dietary supplements and functional foods: 2 sides of a coin?. American Society for Clinical Nutrition, April, pp. 1001S-1007S.
Hans, V., Eussen, S.R.B.M., Loveren, H. v. & Rompelberg, C. J., 2001. Functional foods and dietary supplements: Products at the interface between pharma and nutrition. European Journal of Pharmacology, September, pp. S2-S9.
Hunrer & Trum, B., 1999. The New Dietary Supplement Label. Consumers’ Research Magazine, 82(9), p. 27.
Mason, P., 2001. Dietary Supplements. 2nd ed ed. s.l.:London:Pharmaceutical Press.
MD, W. H. E., 2014. What Are Dietary Supplements and Nutraceuticals?. In: The FDA for Doctors. s.l.:Springer International Publishing, pp. 25-27.
Webb, P.G., 2006. Dietary supplements and functional foods. 1st ed. ed. s.l.:Oxford: Blackwell.
Ransley, J., Donelly, J. & Read, N., 2001. Food and Nutritional Supplements:their role in health and disease. Berlin: London : Springer, c2001.
SFL, K., JE, C., MT, C. & JH, B., 1998. Supplementary issues for women. Nutrition Bulletin, Volume 23, pp. 197-202.
U.S.FDA, 2014. Protecting and Promoting Your Health. [Online]
Available at: http://www.fda.gov/Food/DietarySupplements/default.htm
[Accessed 27 Aug 2014].
Walji, H., 1995. Vitamins, minerals and dietary supplements : a definitive guide to healthy eating. s.l.:London :Headway.
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Dietary Comparison of Athletes

The nutritional requirements of the general population differ from those of athletes.  Basic recommendations designed for the general population include: following a healthy eating pattern throughout the lifespan, focus on an assortment of nutrient dense foods, limit calories obtained from sugar and fat, and decrease consumption of sodium.  A healthy eating pattern would limit trans-fat, saturated fat, sugar, and sodium.  An example of variety and nutrient dense foods would include fruits and vegetables of different colors, including starchy vegetables; whole grains; fat-free or low-fat dairy products (milk, yogurt, and cheese); a assortment of protein, including seafood, lean meats, eggs, beans, and nuts.  The USDA Food Pattern is based on a two-thousand-calorie pattern.  This pattern recommends two to three cups of vegetables, two cups of fruit, six ounces of grains, three cups of dairy, and five to six ounces of protein each day for each food group (US Department of Health and Human Services 2015 pgs. 14-22).  These are the recommendations designed for the general population of the United States.  There are many individuals whose nutrition requirements may vary from those of the general population, in particular athletes require different nutritional needs.  The nutritional requirements of athletes can be further broken down by the type of athlete, (endurance, strength/power, intermittent), as well as pre-competition, nutrition during activity and nutrition after activity is complete.

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 Endurance athletes need to develop a nutritional plan that will help them compete for longer periods of time.  These athletes rely significantly upon carbohydrates to get them through their competitions.  Throughout intense training and competition an athlete should increase consumption of carbohydrates to seventy percent of total calories consumed (ACSM 2009).  It becomes even more important for an athlete to consume a pre-competition meal or a snack high in carbohydrates if the athlete has only consumed insignificant quantities of carbohydrates in the days before the competition, as well as if the athlete has not had an appropriate amount of rest (Rodriguez 2009).  The combination of carbohydrate in addition to protein has been shown to improve performance and decrease muscle damage in endurance athletes.  Immediately before an exceptionally long competition in which it might not be possible to eat, endurance athletes should consume low-glycemic foods.  Low-glycemic foods release glucose gradually which will give the athlete a continual supply of glucose for a longer period of time (Rosa 2011).  Consuming protein, specifically branched chain amino acids (BCAAs), such as chicken, beans, or whole wheat products, throughout endurance exercise might postpone exhaustion (Javierre 2010).  Quickly consuming high quantities of carbohydrates for four to six hours following competition can stimulate the replacement of muscle glycogen (Kerksick 2017).  Foods high in unsaturated fats, such as avocado, fish, and almonds, deliver plenty of energy for endurance athletes (Giuliani 2011).  Endurance athletes must also pay special attention to fluid replacement before, during and following intense training and competition, particularly if exercise extends to more than sixty minutes.  A six to eight percent carbohydrate/sodium beverage is suggested to replenish fluid throughout and following competition.  Carbohydrate beverages have additionally been shown to promote performance and provide steady blood glucose concentrations.  In certain circumstances an endurance athlete might wish to lose weight.  Losing weight gradually is the best method because muscle loss is less likely, and performance will not suffer. 

 Strength/power athletes are normally weight lifters and sprinters.  Their competitions are normally an all-out effort that is quick and does not require an extended amount of time to complete.  These athletes normally consume very large amounts of protein, mostly from liquids and protein powders.  The type of protein consumed is important.  Whey and casein protein are better absorbed than protein from vegetable sources.  Studies have indicated that the small intestine absorbs protein more efficiently in its more complex forms that come from consuming meat (Wolfe 2000).  Individuals involved in strength/power sports require a lower overall consumption of carbohydrates and need to concentrate more on the consumption of carbohydrates in the days immediately ahead of the competition rather than a steady intake of carbohydrates (Escobar 2016).  Strength/power athletes, particularly weight lifters and gymnasts are at risk for marginal nutrition because of pressure to maintain a certain physique.  These types of athletes consistently fall short on enough carbohydrates, protein and fat that is necessary during times of intense training.  Because of this, strength/power athletes are more likely to take vitamins and supplements.  When vitamin consumption from regular food sources, such as fruits and vegetables, is at recommended levels, supplementation has shown no beneficial outcome on protection from muscle injury or healing for strength/power athletes (Yfanti 2010).  The only time that vitamin supplementation would benefit an athlete would be when energy intake is inadequate or poor nutritional selections are made and the athlete is not consuming acceptable quantities of fruits and vegetables (Manore 2000).  A vegetarian athlete might not be able to acquire an acceptable amount of protein from vegetable sources; therefore, supplementation may be required.

 The intermittent athlete is an athlete, such as a football player, who participates in one to five minute stretches with short recovery intervals in between.  Even with a smaller duration of exercise, muscle glycogen reserves are still depleted significantly (Gomez 2008).  Consuming protein and carbohydrates throughout exercise lengthens the time for muscles to fatigue and decreases muscle damage (Hulston 2010).  These athletes turn to energy or protein bars because they are able to be consumed quickly.  While these bars typically contain approximately twenty-five grams of carbohydrates, and fifteen grams of protein, they should only be used on occasion and should not be used as a meal replacement because they are somewhat high in fat.  Hydration is particularly important for football players who frequently practice and play during the summertime months while temperatures are at an extreme.  It is recommended that athletes consume at least five-hundred milliliters of fluid, particularly one with sodium, in the few hours before exercise, and enough to prevent weight loss during and following exercise (Sawka 2007). 

 The Zone Diet is a diet that is popular with athletes.  While on the Zone Diet, each meal contains one-third protein, two-thirds carbohydrates, as well as a small amount of fat.  Calories are calculated on this diet, with women allowed approximately twelve-hundred calories each day, whereas men are allowed approximately fifteen-hundred calories each day.  While on the diet, the athlete is required to have breakfast within one hour of waking up, never allow five hours to pass without eating, and have a small snack before going to sleep every night (Sears 2009). 

 The Eat Clean Diet is a nutrition plan that calls for five to six meals every day, every two or three hours.  Every meal consists of a lean protein along with a complex carbohydrate.  Processed and pre-packaged foods are not permitted, as well as no sugar, soft drinks, juices, or alcohol.  It is also recommended to consume two to three liters of water every day.  This diet might be difficult to follow for busy athletes because of the restriction on pre-packaged foods. 

 Another diet popular among athletes that is similar to the Eat Clean Diet is the Paleo Diet.  The Paleo Diet includes any foods that could be found by hunters and gatherers.  Grains, dairy, refined sugar, potatoes, salt, as well as any pre-packaged foods are not permitted.  The restrictions of this diet make it more challenging to consume carbohydrates which might pose a problem to athletes before and during competition, since carbohydrates are the best form of energy.  As with the Eat Clean Diet, the Paleo Diet may be difficult because of the restriction on pre-packaged foods.

 The nutritional requirements of the three different categories of athletes, are very similar to one another.   Ingesting carbohydrates before and throughout competition is the key to meeting energy requirements particularly for endurance athletes.  Protein is also recommended for all athletes, particularly strength/power athletes and endurance athletes.  Fat consumption for athletes should stay in the range of twenty to thirty-five percent of daily caloric intake.  It is not recommended to consume excessive fat in the diet as the risks of too much fat outweighs any benefits.  Hydration is important for athletes, particularly those who exercise and compete in a hot environment.  Staying hydrated before, during, and following competition is particularly important.  Consuming a beverage with sodium is recommended to replace any electrolytes lost through sweating.  Sports and exercise dieticians frequently recommend the Zone, Eat Clean, and Paleo diet plans for athletes to follow because these diets typically provide enough nutrients and energy to meet an athlete’s requirements.  While the nutritional requirements of the general population differ from those of an athlete, the nutritional requirements between the three athletes are generally very similar with slight differences in some areas based on the type and duration of exercise. 

Sources

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.

American College of Sports Medicine position stand. Nutrition and athletic performance. American Dietetic Association; Dietitians of Canada; American College of Sports Medicine. Med Sci Sports Exerc 2009

Rodriguez NR, Di Marco NM, Langley S. American College Of Sports Medicine Position Stand. Nutrition And Athletic Performance. Med Sci Sports Exerc. 2009

Kerksick, C.; Arent, S.; Schoenfeld, B.; Stout, B.; Campbell, B.; Wilborn, C.;…Antonio, J. International society of sports nutrition position stand: nutrient timing. Journal of the International Soci:ty of Sports Nutrition. 2017. Retrieved from: https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0189-4

Giuliani J.; Owens B.; “Focus on Nutrition May Maximize Sports Performance.” American Orthopedic Society for Sports Medicine. 2011.

Wolfe RR. Protein supplements and exercise. Am J Clin Nutr 2000

Yfanti C, et al. Antioxidant supplementation does not alter endurance training adaptation. Med Sci Sports Exerc 2010

Manore MM. Effects of physical activity on thiamine, riboflavin, and vitamin B6 requirements. Am J Clin Nutr 2000

Gomez-Cabrera MC, et al. Oral administration of vitamin C decreases muscle mitochondrial biogeneesis and hampers training-induced adaptations in endurance performance. Am J Clin Nutr 2008

Hulston CJ, et al. Training with low muscle glycogen enhances fat metabolism in welltrained cyclists. Med Sci Sports Exerc 2010

Escobar KA, Vandusseldorp TA, Kerksick CM: Carbohydrate Intake And Resistance-Based Exercise: Are Current Recommendations Reflective Of Actual Need. Brit J Nutr 2016;In Press.

Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ,Stachenfeld NS. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci              Sports Exerc. 2007

Sears, B. A Week in the Zone: A Quick Course in the Healthiest Diet for You, Harper/Collins, 2009.

 

Effect of Vitamins and Dietary Changes on Dry Eye Disease

Can Dietary Changes and Vitamin Supplements Improve Signs and/or Symptoms of Dry Eye Disease

Introduction

D

Dry eye disease (DED) was first officially defined and classified in 1995, when the report of The National Eye Institute/Industry Workshop on Clinical Trials in Dry Eye was published. This was followed by the Tear Film and Ocular Surface Society (TFOS) publications of the TFOS International Dry Eye Workshop I (TFOS DEWS I) in 2007, and TFOS DEWS II in 2017 (1). Since the first report publication in 1995, the definition of DED has evolved as new research has revealed more information about this multifaceted disease. The most current, globally acknowledged definition of dry eye disease from the TFOS DEWS II workshop (2) is as follows:

“Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.” (p.278)

The ocular symptoms that may accompany DED include ocular discomfort, dryness and visual disturbance, and are reported to increase in severity towards the end of the day (3).

Classification

DED can be broadly separated into two main categories: aqueous deficient and evaporative (2). Aqueous deficient DED can be further classified into Sjogren’s and non-Sjogren’s, while evaporative DED can be further classified into intrinsic or extrinsic (2). The classification of DED can be further broken down into different sub-categories as highlighted by figure 1 (1). 

Figure 1. ‘Major etiological causes of dry eye’ (4: p.77)

Epidemiology

Despite the TFOS DEWS II workshop recently revised definition of DED, there is still no standardized definition (1). Without a standardized definition, determining the epidemiology of DED is difficult to accurately ascertain. Epidemiologic research has thus been conducted with varying diagnostic and inclusion criteria, which has resulted in a wide estimate of DED prevalence. TFOS DEWS II reports that based on signs with or without symptoms, reports of DED prevalence ranges from 5-50% (1). Additionally, there are areas of epidemiological research that need to be focused on in future research, such as DED in younger populations (1). Since age is only one of many possible risk factors contributing to DED, it would be beneficial to draw information from people of all ages affected by DED. Together, a standardized definition of DED, and expanding research to include younger participants, would provide a more accurate picture of the impact of DED.

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It has been estimated that overall, less than 0.1% of DED patients are managed by ophthalmologists in the UK, France, Germany, Italy, Spain, and Sweden (5). Despite this small percentage, within the UK the annual cost of ophthalmologists managing 1,000 patients with DED was estimated to be $1.10 million U.S. dollars, the major cost determinant being prescription drugs (5). Due to the financial burden that DED places on patients and their health care systems, it is worthwhile investigating the role of diet and nutritional supplements and their role in DED.

It is well known that nutritional supplementation or equivalent dietary changes, can positively impact the pathogenesis of many diseases. However, advising nutritional supplements to all dry eye patients may not be physiologically and thus financially beneficial. For example, The Age-Related Eye Disease Study (AREDS) showed that only a specific patient population with age related macular degeneration benefitted from nutritional supplementation with the AREDS formula to reduce the risk of developing advanced age-related macular degeneration (AMD) (#). It may stand to reason, that not all DED patients benefit will from nutritional supplementation or dietary changes, depending on the stage of their disease, current treatment they are receiving or other factors such as genetics which may impact the absorption of nutrients.

 

The ultimate goal of determining the role of nutritional supplements and diet and would be to develop DED supplement supported by evidence based research, and a nutrition guide for DED patients. By determining changes in diet that patients could implement, this could act as a starting point in DED management and prevention during routine sight tests with optometrists.

Objective

The objective of this literature review is to investigate whether or not certain dietary components including omega-3 fatty acids (FAs), vitamin D and antioxidants can alleviate DED signs and or symptoms.

Methods

In this literature review, the review question was whether or not dietary changes or supplements improve the signs and/or symptoms of DED. The following electronic databases were used to gather information: Pubmed, JAMA Network, The National Center for Biotechnology Information (NCBI), Ovid and Science Direct. The language restriction was English, and research publication date needed to be from the year 2000 and onwards. Study types to be included were both qualitative and quantitative, with no restriction on types of study designs that could be included. However, the preferred study design is double blind randomized controlled trials. The context in which the studies were conducted include optometric practice, ophthalmological practice and hospital or university settings.

The condition being studied is dry eye disease. The exposures that were eligible for inclusion were various nutrients such as omega-3 FAs, vitamin D, and antioxidant. The exposures could be taken by the study participants in either supplement form or as dietary changes.  The inclusion criteria for the literature review study participants was any individual with signs and or symptoms of DED, regardless of etiology. The exclusion criteria were those without signs and or symptoms of DED. The exposures of interest for this literature review include omega-3 fatty acids, vitamins and antioxidants. The exposures could be either in the form of dietary changes or supplements/nutraceuticals. Both quantitative and qualitative study designs were included in this review. The primary outcome of interest was statistically significant reduction in the signs and/or symptoms of DED measured at the end of the study in comparison to starting values. There are no secondary outcomes of interest in this literature review.

 

Omega-3 Fatty Acids

Omega-3 fatty acids (FAs) are polyunsaturated fatty acids (PUFAs) which the human body is not able to synthesize itself and is therefore obtained through diet. (6). There are two different forms of omega-3 FAs: one short chain form and two long chain forms. The short chain omega-3 FAs is alpha-linolenic acid (ALA) and the long chain omega-3 FAs include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (6). When ingested, short chain omega-3 FAs can be used by the body to synthesize the long chain FA, EPA (6). Arachidonic acid (AA), is an omega-6 FA and is the precursor to inflammatory mediators involved in the inflammatory cascade (7). Omega-3 FAs are of interest due to their ability to competitively inhibit the conversion of AA into pro-inflammatory molecules (7). Therefore, it is possible that dietary intake of omega-3 FAs, could help reduce underlying inflammation which is believed to play an essential etiological role in the development of dry eye disease.

Dietary sources of omega-3 FAs

ALA

EPA and DHA

Walnuts

Soybeans

Flaxseed

Linseed oil

Oily fish

(herring, salmon, mackerel and tuna)

Table 1. Dietary sources of short and long chain omega-3 FAs (6)

Currently, there is conflicting results with regards to the efficacy of omega-3 FAs and the reduction of DED signs and or symptoms (6). It is interesting that for a disease in which it is recognized that inflammation plays a major etiological role, the supplementation of omega-3 FA which has anti-inflammatory properties, yields such variable results.

A meta-analysis of 17 randomized clinical trials (RCTs) included a total number of 3,363 participants (6). The analysis in this study shows a significant improvement in DED signs and symptoms with omega-3 supplementation across, Schirmer test scores, tear break up time (TBUT) and corneal staining with fluorescein (6). The studies included in this meta-analysis were conducted in the United States, India, Europe, Australia, Japan and Iran. The sources and doses of omega-3 FAs varied across studies. Sources of omega-3 FAs included: EPA, DHA, krill oil, fish oil, sea buckthorn oil, flaxseed oil and borage oil. Further analysis of the study’s results revealed that location had a significant impact on results. Studies performed in India were found to have significantly greater improvements of DED symptoms and increased TBUT in comparison with the other countries included in the meta-analysis. The authors postulate that the high prevalence of vegetarian diet in India predisposes the population to lower omega-3 intake (6). To the best of their knowledge, the authors believe this to be the largest meta-analysis to date that investigates the role of omega-3 FAs on the signs and symptoms of DED (6). While this meta-analysis provides evidence to support that omega-3 FAs can improve DED, it also reveals the many differences in methodologies between the studies. In particular, the variation in sources of omega-3, inclusion criteria and ethnicity of participants. All of these factors may influence study results and are very possibly contributing to the conflicting evidence to support whether or not omega-3 FAs are beneficial for people suffering with DED. It may be best, therefore, to take a more one on one approach when evaluating the evidence for omega-3 FAs, considering these factors and looking for similarities between studies with similar methodologies. For example, comparing the results of a study that allowed participants to continue current dry eye treatments, to another study where participants were only allowed the exposures of interest, will likely provide conflicting results. Therefore, when considering study results clinicians should keep in mind the source of omega-3 used, inclusion criteria and ethnicity of participants.

Omega-3 FAs are available from a variety of sources, which includes oily fish, walnuts, flaxseed, linseed oil and soybeans (6). It is important to be aware of the sources of omega-3 FAs used in research, as not all sources may be equivalent, as some may be more bioavailable than others. In a randomized, double-masked, placebo-controlled clinical trial, omega-3 from both fish oil and krill oil were compared against each other and a placebo oil (olive oil) (10). It was found that moderate supplementation with either fish or krill oil significantly improved DED signs and symptoms over a 3-month period (10). Additionally, krill oil was found to be more efficacious in improving DED symptoms and decreasing inflammatory markers compared to fish oil supplementation. Krill oil also has better stability, which is conferred by the antioxidant astaxanthin, a carotenoid, which is found in krill oil (10). In a different study, the bioavailability of fish oil and krill oil were compared (11). The results showed no significant differences in total plasma levels of EPA and DHA between fish and krill oils supplementation (11). However, this study was conducted for only 28 days, in comparison to the 3-month period the other study took place over.

It is important that clinicians evaluate the inclusion criteria for study participants when considering the applications of the study results with their own patients’ individual needs. While there are few reported adverse effects of omega-3 supplementation (6), some patients may be less responsive than others to the possible beneficial anti-inflammatory effects on their DED. In a recent study, The Dry Eye Assessment and Management (DREAM) Study Research Group evaluated whether or not omega-3 supplementation improved signs and symptoms of DED in 535 participants over 12 months (9). This study was designed to reflect the real-world applications of the benefits of omega-3 FAs on DED (9). Unlike the inclusion criteria of most studies, patients in the DREAM study were allowed to continue current DED treatments. Treatments included various modalities, such as artificial tears, cyclosporin drops and warm lid soaks for the 12-month duration of the study. The study results show that in patients with moderate to severe DED, there was no significant benefit of omega-3 FA supplementation in comparison to the placebo (olive oil). Both the treatment group and the placebo group displayed improvements in DED signs and symptoms, and the authors concluded that there was no statistical difference in improvement between groups (9). The results of this study suggest that for patients already receiving treatment for moderate to severe DED, omega-3 FA supplementation may be of no additional benefit. By no means should this study be taken as conclusive evidence that omega-3 FAs have no beneficial anti-inflammatory properties for people suffering with DED. Instead, this information can help guide clinicians as to which patients might benefit most from supplementation of omega-3 FAs.

Vitamin D

Vitamin D is a fat-soluble vitamin with anti-inflammatory and immunomodulatory properties (11, 12,), which may have applications to managing the signs and symptoms of DED (12). 

Vitamin D is available from 2 sources: sunlight and food (14). When exposed to direct sunlight, the body is able to synthesize Vitamin D. However, in the UK there is not enough sunlight between the months of early October to early March to obtain the required amount of vitamin D (14). Children over the age of 1 year, and adults (including pregnant and breastfeeding women and people who are at risk of vitamin D deficiency), require 10 micrograms of vitamin D a day (14). From food, vitamin D is found predominantly in oily fish, meat and eggs. It is important to note that in the UK, milk is not fortified as it is in other countries and is therefore not a good source of vitamin D (14).

Sources of Vitamin D

Oily Fish: salmon, sardines, herring, mackerel

Red meat

Liver

Egg yolks

Fortified foods (such as fat spread & most cereals)

Table 2. Dietary sources of vitamin D (14).

There has been a recent interest in the association between vitamin D supplementation and DED. Research has demonstrated that patients with low serum vitamin D levels might be at higher risk of developing DED (12, 13). Due to the increased risk of the development DED in patients with auto-immune diseases, it is possible that the immunomodulatory and anti-inflammatory properties of vitamin D supplementation could help reduce the risk of DED in these patients (12).Decreased serum levels of vitamin D have been shown to significantly reduce TBUT, Schirmer test scores and ocular surface disease index (OSDI) scores. (13).

Vitamin D may be a beneficial supplement for patients with vitamin D deficiency and DED that has responded poorly to conventional treatment. Bae et al (15) investigated the effect of intramuscular injection of cholecalciferol (vitamin D3) on the signs and symptoms of DED in participants whose DED was not manageable with artificial tears or liposic EDO. Patients with autoimmune diseases, history of corneal surgery or disease, and corneal opacities were excluded from this study. The results showed an improvement of both DED signs and symptoms over a ten-week period (15). Vitamin D supplementation was associated with significantly improved TBUT, fluorescein staining score, hyperaemia of the eyelid margins, Schirmer test scores, OSDI score and the vision analogue pain score (15). Sub analysis showed that both men and women had increased TBUT, however, only women demonstrated a significant improvement in fluorescein staining scores and tear secretion (15). Out of 104 participants, 21 were male and 84 were female. The gender imbalance in this study could contribute to the statistically different results when stratified by gender. It would be beneficial to conduct a larger trial with equal male to female participants to investigate whether this was a result of gender bias, or if there is perhaps an underlying biological mechanism in which women respond better to vitamin D supplementation with regards to DED.

 DED signs and symptoms may not always correlate in severity (16). There are some patients who experience exaggerated symptoms of DED, but present with little to no signs of the disease (16). In a study by Shetty et al (16), inflammatory cytokines were measured in patients with DED symptoms, but little to no signs of DED. The authors postulate that low serum vitamin D levels might influence inflammatory cytokines or alter corneal pain perception in DED, which could result in fewer signs of DED, but with out of proportion symptoms (16). Diagnosing and managing these patients could prove difficult. The study found a significant correlation between lower serum vitamin D levels and altered inflammatory cytokines in patients with little to no signs of DED, but who were presenting with out of proportioned symptoms (16).

 

Discussion

Weaknesses in studies

–          Different grading scales

–          Lack of standardized definition

–          Comparison between studies that are not equivalent and drawing conclusions

–           

Future Research/Areas of Interest

–          Anti-inflammatory diets

–          Sugar intake; not only adding anti-inflammatory supplements/food to diet but reducing/eliminating pro-inflammatory foods. From the studies evaluated in this literature review, evaluation of current diet was not taken into account.

–          Including genetic analysis regarding omega-3 FA serum levels in future research involving omega-3 FAs and its impact on dry eye disease.

Conclusion

(1) Nelson JD, Craig JP, Akpek EK, Azar DT, Belmonte C, Bron AJ, et al. TFOS DEWS II Introduction. The Ocular Surface. 2017; 15 (3): 269-275. Available from: http://dx.doi.org/10.1016/j.jtos.2017.05.005 [Accessed Feb 2nd, 2019]

(2) Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK et al. TFOS DEWS II Definition and Classification Report. The Ocular Surface. 2017; 15 (3): 276-283. Available from: http://dx.doi.org/10.1016/j.jtos.2017.05.008 [Accessed Feb 2nd, 2019]

(3) Begley CG, Chalmers RL, Mitchell GL, Nichols KK, Caffery B, Simpson T, et al. Characterization of Ocular Surface Symptoms From Optometric Practices in North America. Cornea. 2001; 20(6): 610-618. Available from: https://insights.ovid.com/crossref?an=00003226-200108000-00011 [Accessed Feb 2rd, 2019]

(4) The Definition and Classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop. The Ocular Surface. 2007; 5(2): 75-92. Available from: https://doi.org/10.1016/S1542-0124(12)70081-2 [Accessed Feb 2nd, 2019 ]

(5) Clegg JP, Guest JF, Lehman A, Smith AF. The Annual Cost of Dry Eye Syndrome in France, Germany, Italy, Spain, Sweden and the United Kingdom Among Patients Managed by Ophthalmologists. Ophthalmic Epidemiology. 2006; 13: 263-275. Available from: https://doi.org/10.1080/09286580600801044 [Accessed Feb 5th, 2019]

(6) Giannaccare G, Pellegrini M, Sebastiani S, Bernabei F, Roda M, Taroni L, et al. Efficacy of omega-3 Fatty Acid Supplementation for Treatment of Dry Eye Disease: A Meta-Analysis of Randomized Clinical Trials. Cornea. 2019; 38(5): 565-573. Available from https://insights.ovid.com/pubmed?pmid=30702470 [Accessed Feb 5th, 2019]

(7) James MJ, Gibson A, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. The American Journal of Clinical Nutrition. 2000; 71(1): 343S-8S. Available from: https://doi.org/10.1093/ajcn/71.1.343s [Accessed Feb 5th, 2019]

(8) Hom MM, Asbell P, Barry B. Omegas and Dry eye: More Knowledge, More Questions. Optometry and Vision Science. 2015; 92(9): 948-956. Available from https://www.ncbi.nlm.nih.gov/pubmed/26164311 [Accessed Feb 5th, 2019]

(9) Asbell PA, Maguire MG, Pistilli M, Ying GS, Szczotka-Flynn LB, Hardten DR et al. n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. New England Journal of Medicine. 2018; 378(18): 1681-1690. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29652551. [Accessed Feb 15th,2019]

(10) Deinema LA, Vingrys AJ, Wong CY, Jackson DC, Chinnery HR, Downie LE et al. A Randomized, Double-Masked, Placebo-controlled Clinical Trial of Two Forms of Omega-3 Supplements for Treating Dry Eye Disease. American Academy of Ophthalmology. 2016; 124(1): 43-52. Available from http://dx.doi.org/10.1016/j.ophtha.2016.09.023. [Accessed March 7th]

(11) Yurko-Mauro K, Kralovec J, Bailey-Hall E, Smeberg V, Stark JG, Salem N. Similar eicosapentaenoic acid and docosahexaenoic acid plasma levels achieved with fish oil or krill oil in a randomized double-blind four-week bioavailability study. Lipids in Health and Disease. 2015; 14(99). Available from https://www.ncbi.nlm.nih.gov/pubmed/26328782

 [Accessed on March 7th].

(12) Kurtul BE, Aydinli MS. The association of vitamin D deficiency with tear break up time and Schirmer testing in non-Sjogren dry eye. Eye. 2015; 29: 1081-1084. Available from https://www.ncbi.nlm.nih.gov/pubmed/26066054 [Accessed March 7th]

(13) Meng, YF, Lu J, Xing Q, Tao JJ, Xiao P. Lower Serum Vitamin D Level Was Associated with Risk of Dry Eye Syndrome. Medical Science Monitor. 2017; 23: 2211-2216.

(14) Vitamins and Minerals: Vitamin D. NHS. Page last reviewed 03/03/2017. Available from https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/. [Accessed March 7th]

(15) Bae SH, Shin YJ, Kim HK, Hyon JY, Wee WR, Park SG. Vitamin D Supplementation For Patients with Dry Eye Syndrome Refractory to Conventional Treatment. Scientific Reports. 2016; 6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27698364. [Accessed April 2nd]

(16) Shetty R, Sethu W, Chevour P, Deshpande K, Pahuja N, Nagaraja H et al. Lower Vitamin D Level and Dising Tear Cytokine Profile Were Observed in Patients with Mild Dry Eye Signs but Exaggerated Symptoms. Translational Vision Science and Technology. 2016; 5(6): 1-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156440/. [Accessed April 2nd].
 

School Dietary Restrictions Analysis

Americas government is helping kids lives by having dietary restrictions in school cafeterias.
Just like you need to put fuel into your car or recharge your phone, your body needs to be fed food that provides it with energy every day. Giving your body tones of sugar, or lots of calories a day is not healthy for you. Food like soda, candy, and fatty foods don’t do well for your body. It makes your body gain weight and have unnecessary fat.

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Your body needs certain things that should be incorporated into your daily intake. Men/boys and women/girls have certain needs but not quiet the same. “Men need an average of 2,400 calories per a day to maintain a healthy body weight.”(sfgate.com). “Women need between 2,000-2,200 calories per a day.” (sfgate.com). Your body needs five main nutritional needs daily. Fiber, can lower risk of diabetes and heart disease. Which fiber can be found in fruits, vegetables, whole grains, and legumes which is a member to the pea family. Vitamin D, which your body needs everyday. Easiest way for your body to produce vitamin D is through 15 minutes of sun exposure. Essential for healthy bones and neuromuscular function. This one is a no brainer which is water, the most important thing to intake each day. The health authorities commonly recommend 8-ounce glasses, which equals 2 liters, or half a gallon a day. Which this is called the 8×8 rule which is easy to remember. Also depending on your overall health, activity level, and where you live depends on how much water you should drink daily. Calcium, is important for proper growth also development of the skeletal system, which the average persons body stops growing around the ages 18-24. Calcium, can aid in weight loss. Calcium also prevents certain cancers like colon cancer which is a cancer of the rectum and colon. It often begins as a polyp-a tissue growth in the colon or rectum. Rich foods like milk, bean curd, or dried apricots all have calcium. Which is crucial for brain and heart health. Sources of Omega-3 include fish oil, and certain plant/nut oils, reducing the risk of heart attacks, strokes, and lowering blood pressure which many kids in school suffer from low/high blood pressure.
As there are many things that your body needs, your body also doesn’t need many things as well. There is a long list of bad things for your body. One of the main things that you should never start your day with is sugar! Sugar is the devil to your body. Sugar has many bad effects to your body especially that you don’t need during school. Sugar can cause anxiety, difficulty concentrating, and causes crankiness in children. Sugar can cause tooth decay, also can weaken eyesight. Many kids in school suffer from obesity. About 30% of America are obese. From the slightest to the largest. Sugars are proven to make us fat, sugars also contribute to heart disease.
What most humans eat day to day without thinking twice about it is fried foods. Fried foods don’t just damage your body but also your brain in many different ways. Just as a car needs good oil to run efficiently and not break down, your body needs food that can be digested properly and not clog the one and only “machine” you have for your entire life. Fried foods do many things to your body it can clog your arteries, also can clog your veins which can lead to heart attacks. Fried foods leads to obesity. Obesity, basically means people are storing fried foods and carbohydrates as body fat. First lady Michelle Obama launched a campaign to end childhood obesity entitled the “lets move” campaign the goals are to, improve school food quality, making healthy foods affordable and accessible, focusing of physical education and getting parents informed about nutrition and exercise. By empowering children’s parents and caregivers the information and tools they need to make good choices for themselves and their families. They will help our children develop lifelong healthy habits, which will bring us closer toward becoming a healthier America.
Schools need to improve food quality. Not just to make them healthier, but also to make the portions larger. Many kids in school only eat at school because, they can’t afford food at home. An abundant amount of kids rely on one meal a day, which is at school. There should be larger portions, because when kids don’t have proper nutrition they lack focus.
Everyone’s body is different and we all need the same needs in most cases but in all different portions. All depending on your weight, height, and much more. Learning portion control can help with obesity as well. Kids who are over weight are usually getting too many calories or, aren’t active enough, or both. When calories are a problem, it can be that they are drinking too much whole milk, juice, soda, or eating high-calorie foods, high-fat foods, and junk foods too often or in portions that are too large. Good nutrition means eating the right kinds and amount of food. It keeps you in good shape by limiting the amount of calories. To keep children in school from getting too many calories, understanding portion sizes can be a good place to start. Kids in school need a daily intake of vegetables, fruit, and calcium. To have a balanced meal throughout the day. Several studies show that nutritional status can directly affect mental capacity among school-aged children. Provide a balanced diet for better behavior and learning environments. Promote diet quality for positive school outcomes. School cafeterias need to balance out their food proportions, and what children should have a daily intake of.
Nutrition is the process of consuming food and having the body use it as raw materials for growth, fuel, and function. But there are various parts that comprise overall nutrition, including actual nutrients, reasons to eat healthy, ways to eat smart, and much more. There are many benefits to eating healthy. Healthy eating can help individuals achieve and maintain a healthy body weight, consume important nutrients, and reduce the risk of developing health conditions such as high blood pressure, heart disease, diabetes, cancer, and iron deficiency. Healthy eating in schools is important for proper growth and development also to prevent various health conditions. The 2015-2020 dietary guidelines for Americans recommend that people aged two years or older follow the healthy eating pattern that includes varieties of fruits, vegetables, whole grains, fat-free and low-fat dairy products, variety of protein foods, and oils.
There are many different ways schools need to change their food. Since there are many students that have allergies, also are many vegetarians, religious believes where students can only eat certain things, and many students have diseases where they can’t eat various of thing’s. The government doesn’t realize what they need to provide for their students in school. Also the procedures that teachers and staff members need to train on if there is every an emergency, like if there is a student having a severe food allergic reaction.
Many schools don’t realize is that many kids in school have severe allergies and can’t eat various things. One in every 13 children have severe food allergies. “Very small amounts of food allergen can cause anaphylaxis (severe, life threatening, allergic reaction).” (Michael Pistiner MD,MMsc). To prevent accidental exposure those responsible for students must effectively read labels, prevent cross contact, use efficient cleaning strategies, and communicate clearly with others. Those responsible for students must be able to recognize a allergic reaction, have treatment of choice for anaphylaxis available, know when and how to use it, and know to contact emergency services immediately. These strategies are always necessary. Educating and understanding school communities (nurses, administration, staff, cafeteria workers, parents, and students) can create safe and supportive environments for children with severe food allergies. Especially letting the cafeteria workers know that a student has a severe food allergy can help the student avoid contact with the allergy reactant. By having a separate area in the cafeteria where students with severe allergies can sit and get different care that’s needed. Care that’s needed for children with severe food allergies would be having a different food line than others, that can help with there allergy needs. By doing this and changing the cafeteria food to help others with their allergies will reduce emergency allergic reactions in schools.
There are many diseases that children in school have. Celiac disease is one of the top diseases in school that students have, which the “immune reaction to eating gluten, a protein found in wheat, barely and rye. This causes bloating and diarrhea.” (The editors of encyclopaedia britannica). Which making school food in the cafeteria all gluten free will help students with this disease eat what they’re able to eat. Students have there different religions not everyone believes in the same things. Many religion like the religion Judaism, are restricted from eating ‘unclean’ foods like the pig. Also the Hindus don’t eat beef because, the cow is a sacred animal. By the school having different food lines to provide students with meals or having a paper/sign to tell the students with this disease or different religion what they can and can’t eat will help them greatly. By doing this it will help outbreaks of their disease.
Many students have daily encounters of foods that they’re not able to consume. By having dietary restrictions in school cafeterias, it’ll help students lives by helping them with their daily needs. Just by changing the menu slightly will help students in various of ways. Students with allergies that aren’t able to eat certain thing’s will be able to have more choices. Just by adding more food lines in the cafeteria to avoid encounters of nut allergies will help with less allergy breakouts. Also by helping students with certain diseases and giving them a daily chart of what’s in the cafeteria, or making all foods gluten free will help their daily lives. Just by making these simple changes in school cafeterias it can help change the world.
(Michael pistiner MD, MMsc)
www.allergyhome.org
“Very small amounts of food allergen can cause an anaphylaxis (severe life threatening, allergic reaction)”
(The editiors of encyclopaedia britannica)
www.britannica.com
“immune reaction to eating gluten, a protein found in wheat, barely, and rye. This causes bloating and diarrhea.”
www.sfgate.com
“Men need an average amount of 2,400 calories per a day to maintain a healthy body weight.”
www.sfgate.com
“Women need between 2,000-2,200 calories per a day”

Analysis of Dietary Causes and Effects

Introduction

There is an obvious relationship between nutrition and lifestyle, leading to a variation in an individual’s diet every day. Hence, it is challenging to maintain the right amount of nutritional intake for the body’s needs as lifestyle factors, for instance, work can affect one’s eating patterns. In my case, I struggled to achieve a healthy eating pattern due to several circumstances including work schedule and university. This project will discuss the causes and effects of my own diet of 5 days, Monday to Friday, including social, family and individual factors.

Methods

I have chosen a subjective method approach of a 5-day estimated food diary of which I have recorded through the MyFitnessPal application. The application has allowed me to measure my nutrient intake, including breakfast, lunch, dinner, snacks and water intake, through the process of estimating my portion sizes or scanning the barcode of products in the application. Moreover, it also calculates the number of calories I have consumed and burned from exercise. I have selected the lose weight option that sets a target for the number of macronutrients and kilojoules I should be attaining, and the application also calculates micronutrients that make it easily assessable for individuals due to the variety of analysis.

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I have chosen this method due to its accessibility as a mobile application compared to other methods such as a 24-hour recall as I can record for a longer period of time for more accurate analysis of my diet. Others such as food frequency questionnaires are challenging for me as I would rather record my food intake straight away than all at once following a specific period of time, establishing more accurate results in contrast to a frequency scale. 

Results

My recommended intake, according to the MyFitnessPal app, is 6,569 kilojoules per day of which 50% should be carbohydrates, 20% protein and 30% fat. Four out of the five days of tracking my intake, I did fall under the recommended kilojoule intake, however, on some days I exceeded the macronutrient percentage of one and fell under a requirement of another. For example, on Tuesday I exceeded the recommended fat consumption from 30% to 52% but had inadequate portions of carbohydrate; consuming 28% instead of 50%.

Breakfast was the highest kilojoule intake of the day for every day except the day that I did not have breakfast; Wednesday. On Tuesday however, dinner was exceptionally higher than breakfast and additionally, it was the only day that I exceeded the recommended kilojoule intake by a difference of 4,338.

On Monday and Thursday, dinner intake was exceptionally low, 690kjs and 749kjs respectively. For instance, Monday’s dinner only consisted of a brown rice tuna and avocado sushi roll that contained 3g of fat, 5g of protein and 31g of carbohydrates. Additionally, on Tuesday and Wednesday, I ate outside of home whereby dinner portions were larger in comparison to the other days. Snacks and water intake varied every day, however, intake of water daily was significantly low. 

Discussion

Firstly, as the chosen option to lose weight was set up on the app, the recommended macronutrient intakes were based on a default goal setting of which I did not modify. This, in turn, led me to focus on reaching these targets, influencing my dietary behaviours. These ratios are derived from the Acceptable Macronutrient Distribution Ranges (AMDR), although, they are not entirely appropriate for weight loss as it is established for individuals who wish to maintain their body weight (Australian Bureau of Statistics, 2015). Hence, this gives rise to the questioning of appropriate ratios that an individual should follow to lose weight where in contrast, the CSIRO recommends a higher protein diet to increase fat loss and preserve muscle growth (Noakes, 2018). Hence, as my dietary behaviour was influenced by the suggested ratio of macronutrients, this may lead to the inability to lose weight in the long-term.

The type of food consumed on Tuesday and Wednesday evening was predominantly influenced by my family and friends. Most locations and the type of food ordered are mainly chosen by my parents during family dinners as they bear the expenses. Similarly, on Tuesday night I was surrounded by my friends that played a role in the choice of dinner and I was less conscious of the amount of food consumed. This is supported by studies that show how parents and peers contribute to an adolescent’s habit of eating, that may result in obesity

(Salvy et al., 2012). If this dietary behaviour of eating out becomes consistent, there is a possibility of weight gain as a long-term effect due to exceeding the amount of kilojoule intake recommended to lose weight on the MyFitnessPal app.

My dietary behaviours were also influenced by the psychological thought of eating healthy, especially post-exercise. Specifically, on the days that I went to the gym in the morning, breakfast was dominated by protein as I personally believed it was necessary for muscle repairment. For example, on Thursday, 36% of the protein consumed on the day was during breakfast, compared to 14%, 24% and 25% during lunch, dinner and snacks respectively. Consequently, recent evidence also indicates it’s long term effects in improving recovery and immune functioning. (Kreider and Campbell, 2009). Alongside this, with knowledge and beliefs obtained over time, I have come to value breakfast as the most significant meal shown through the consistency of having meals in the morning with the exception of Wednesday. Hence, long-term effects include the protection of cardiometabolic health and the maintenance of a balanced diet that can result in weight loss (Smith et al., 2010). Furthermore, being knowledgeable about the importance of eating enough vegetables, I encouraged my parents to choose healthier dishes during family dinners, such as Tuesday night. As I have previously read the Australian Dietary Guidelines, I am recommended to consume 5 serves a day of which is beneficial in the short run as it can reduce hunger and in the long run by protecting individuals against chronic diseases including heart disease (National Health and Medical Research Council, 2013). Although my perspective on healthy eating is distinct from others, for example, a dietician would know what foods to consume specific to targeting weight loss whereas my behaviour stems from previous knowledge and beliefs obtained over time. Hence, personal beliefs on health contribute to dietary behaviours.

Other factors such as a busy schedule have also influenced my dietary behaviour. For example, on Wednesday due to time constraint having needed to attend a class at university, I was unable to have breakfast after exercising. In the short-term, I consequently felt tired due to the lack of energy specifically after high-intensity training. A solution to this could be to improve on time management and workout earlier. In addition, breakfast skipping can lead to an increased 24-hour glycaemia (Kobayashi et al., 2014) that can lead to the development of type 2 diabetes. Similarly, Monday and Thursday dinner intakes depicted my inability to eat at an appropriate time as I had worked night shifts, consuming dinner at around 11 pm. These foods were convenient to eat as they were leftovers from the restaurant, although they were not large portions nor were they nutritional. Hence, a busy schedule contributes to a poor diet that can consequently affect health and weight as I fail to achieve the recommended nutrient intake.

Additionally, as my dietary behaviours were affected by the concerns of reaching the target ratios of macronutrients, this was not entirely accurate as the kilojoules burnt during exercise were not accounted for. This is due to the difficulty in tracking specific weighted exercises that I performed at the gym. Hence, on the days that I did engage in physical activity, the difference in the intake should have been much less on the days I exceeded and much more on the days that I was under. As such, I could have been more or less conscious of what I had consumed having known that I was further away from the recommended kilojoule intake. Also, my dietary behaviour may have been impacted by subconscious acts of eating healthily due to the awareness of having to put my consumptions on record. Furthermore, water intake was very low on all days that can “increase the risk of kidney stones and, in women, urinary tract infections” (Better Health Channel 2014).

Thus, my dietary behaviour is shown to be affected by the MyFitnessPal application, my social and cultural environment, which includes friends, family, university and work, as well as personal beliefs and knowledge.

References

Australian Bureau of Statistics, Food Standards Australia New Zealand 2015. Acceptable  Macronutrient Distribution Ranges. Australian Bureau of Statistics, Canberra.

Better Health Channel 2014, Government of Victoria, accessed 13 July 2019,  https://www.betterhealth.vic.gov.au/health/healthyliving/water-a-vital-nutrient>

Kobayashi, F., Ogata, H., Omi, N., Nagasaka, S., Yamaguchi, S., Hibi, M. & Tokuyama, K. 2014. Effect of breakfast skipping on diurnal variation of energy metabolism and blood glucose. Obesity research & clinical practice, 8, e249-e257.

Kreider, R. B. & Campbell, B. 2009. Protein for Exercise and Recovery. The Physician and Sportsmedicine, 37, 13-21.

National Health and Medical Research Council 2013. Australian Dietary Guidelines.  National Health and Medical Research Council, Canberra

Noakes, M. 2018. Protein Balance: New Concepts for Protein in Weight Management.  CSIRO, Australia.

Salvy, S.-J., De La Haye, K., Bowker, J. C. & Hermans, R. C. 2012. Influence of peers and friends on children’s and adolescents’ eating and activity behaviors. Physiology & behavior, 106, 369-378.

Smith, K. J., Gall, S. L., Mcnaughton, S. A., Blizzard, L., Dwyer, T. & Venn, A. J. 2010. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. The American Journal of Clinical Nutrition, 92, 1316-1325.

 

Effects of Dietary Management on Symptoms of Hypertension

Introduction
Hypertension is a cardiovascular condition continuously on the rise due to many modifiable and nonmodifiable risk factors. The effects of this condition are manageable yet can also lead to rapid decline. According to recent studies, hypertension (or high blood pressure) is the primary contributor to cardiovascular disease and is the leading cause of morbidity and mortality worldwide (Mohamed et al., 2018, p. 9). Jones, Forouhi, Khaw, Wareham, and Monsivais (2018) go on to say, “Cardiovascular disease (CVD) is the most common cause of death in the world and was estimated to account for 32% of all deaths in 2013 (p.235).” Sanuade, Boatemaa, & Kushitor (2018) studied hypertension prevalence, awareness, treatment and control in Ghanaian population and globally stating, “Recent evidence shows that between 1990 and 2015, there has been an increase in hypertension incidence, prevalence, and deaths globally [2]” (p.1).

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As a result of these statistics, lifestyle modifications were researched to learn how patients diagnosed with hypertension can control their condition and reduce their risk for health decline. Dietary management and its effect on hypertension were the focal points during research. The interventions of interest are shown by studies done to assess the effect and correlation of dietary management on symptoms of hypertension. 
The PICO question guiding this paper is, in patients with hypertension, how does dietary management compared to no dietary management affect the symptoms of this chronic illness? The intent of this paper is to address the effects of dietary management and no dietary management in patients who have hypertension. This issue will be addressed through evidence presented in research studies expanding on dietary management resulting in weight loss, decreased obesity, and decreased symptoms of hypertension. Nurses play an important role in the lives of patients diagnosed with hypertension because they encounter them every day.
Nurses, as health care professionals, are responsible for educating their patients. Patients with hypertension should be educated on the effects of poor dietary management with this condition and the benefits that proper nutrition can yield. This paper provides evidencbout the management of hypertension to provide nurses with additional knowledge, so they are more equipped to educate their patients.
Literature Review
The articles discussed provide evidence on the effects of dietary management compared to no dietary management in patients with hypertension. Three topics were identified while reading the evidenced based research. The first topic involved foods to be avoided in patients with hypertension and foods that should be consumed to decrease the risk of progression into cardiovascular disease. The second topic was how weight loss can benefit someone diagnosed with hypertension and the third expanded on how exercise effects patients with hypertension.  Therefore, all articles researched discuss the effects, benefits, and importance of dietary management and other aspects regarding hypertension.
Diet
According to the article written by Jones et. al (2018), prioritizing a healthy diet significantly benefits someone diagnosed with hypertension (p.325). In this study, two trials were done to test the effects of dietary management. In this article Jones et. al (2018) states,
A diet based around nutrient targets – specifically reduced fat intake – was found to be less effective at reducing risk of CVD events than a dietary pattern based around changing the consumption of fruit, vegetables, whole grains, fish, nuts, dairy products and vegetable oils, and reduced consumption of processed meats, sugars, desserts, alcohol, and fats (p. 236).
Most patients who have hypertension see a decline in their health due to poor dietary management. Neglected nutrition can cause a buildup of lipids which results in an elevation of blood pressure. This can further lead to an increased risk for cardiovascular disease. Foods that cause this decline include processed meats, sugars, desserts, alcohol, fats, and red meats (Jones et. al, 2018, p. 235). Conversely, Jones et al. (2018) states consuming a diet of fruit, vegetables, legumes, whole grains, and low-fat dairy as opposed to fatty alternatives, significantly lowers the risk for decline with hypertension (p. 235). However, when regarding dietary management, education and compliance are priority. One risk for gathering self-reported data is that the patient may withhold their entire daily intake, causing error in dietary regiment. This results in possible increased blood pressure and risk for cardiovascular disease. Thus, emphasizing the importance of dietary management for prevention of chronic disease. 
Weight Loss
Poorolajal, Hooshmand, Bahrami, and Amen (2017) reviewed the next topic found, being the association between weight loss and incidence rate of hypertension (p, 95). Hypertension is a condition not only associated with overweight or obese individuals, but in comparison to normal weight, overweight can increase the risk of hypertension (Poorolajal et. al, 2017, p. 95). Poorolajal et. al (2017) expands on this statistic in his article by stating, “Raised blood pressure is a major risk factor for cardiovascular disease and stroke (p. 95). Evidence has shown that raised blood pressure happens in individuals of all body sizes, ranging from lean to obese. However, people who are overweight or obese are greater risk of developing high blood pressure” (Poorolajal et. al, 2017, p. 95). Due to this risk factor, the purpose of this article was specifically to provide evidence on if weight loss is a beneficial method of controlling hypertension and decreasing risk for cardiovascular disease. This research specifically expanded on “the effect of overweight and obesity on the risk of raised blood pressure and estimated the amount of relative reduction in the incidence of hypertension that may occur if excess body weight is controlled” (Poorolajal et. al, 2017, p. 95). The eligibility criteria were clearly stated, including explanations as to what overweight and obesity are defined as.
The exposure of interest was overweight and obesity. Overweight refers to a BMI between 25 and 29.9 kg/m squared. Obesity refers to a BMI equal to or >30 kg/m squared. The outcome of interest was high blood pressure so called hypertension. Hypertension refers to a mean systolic/diastolic blood pressure at or above 140/90 mmHg (Poorolajial et. al, 2017, p. 95)
One measure utilized was Attributable Risk Fraction (AFR), which indicates how much of the relative prevalence of raised blood pressure will reduce per specified weight loss. Researchers determined the evidence presented by gathering a variety of data from studies and data extracted from other research articles, comparing weight loss to the effects on overweight and obese patients with hypertension. Through comparing data, researchers found that the effect of weight loss had a positive correlation on the reduction of incidence rate in hypertension and decreased risk for future cardiovascular disease. According to the results and statistics, the article’s conclusion was that weight loss can effectively reduce the incidence rate of hypertension, therefore, excess weight loss is a vital strategy for controlling hypertension and is sufficient for achieving the global target relative reduction in the incidence of raised blood pressure (Poorolajial et. al, 2017, p. 95).
Exercise
An article written by Pescatello, McDonald, Lamberti, and Johnson (2015, p. 87) specifically expands upon the topic of the effects of exercise on hypertension. Through a series of randomized controlled trials, researchers were able to administer a variety of amounts of exercise including acute and chronic aerobic, dynamic resistance, and concurrent exercise ranging from 30-60 minutes each day on patients who were diagnosed with hypertension. After these exercises were administered, blood pressure was taken and recorded.
Numerous randomized controlled trials (RTCs) have been conducted investigating the antihypertensive effects of exercise…These meta-analyses concluded that aerobic exercise training lowers blood pressure (BP) 5-7 mmHg, while dynamic resistance training lowers BP 2-3 mmHg among adults with hypertension. The magnitude of these BP reductions rivals the magnitude of those obtained with first-line antihypertensive medications and lower CVD risk by 20-30% (Pescatello, et. al, 2015, p. 87).
Based on the results of the study, it was concluded that practicing regular exercise significantly reduces blood pressure. Therefore, making exercise a key modifiable determinant of hypertension that should be prioritized to reduce the significance of hypertension and its effects to those who are diagnosed with this condition (Pescatello et. al, 2015, p. 87). 
The biopsychosocial aspects related to hypertension include obesity, depression, and cardiovascular disease. Most individuals who are diagnosed with hypertension often lack diet management and exercise, which results in overweight or obesity. Obesity becomes psychosocially problematic when body image and self-esteem significantly decline, which can lead to depression. In addition to the biological aspect of obesity, untreated hypertension or noncompliance to a treatment plan leads to an increased risk for cardiovascular disease. If untreated, hypertension can cause an overall decline, frequently leading to obesity, depression, and cardiovascular disease.
Discussion
A.D., a 73-year-old male diagnosed with hypertension about two years ago was the subject interviewed throughout this process. Research found suggested that to decrease symptoms of hypertension and prevent further decline, patients diagnosed should practice diet management, prioritize weight loss, and exercise frequently. If compliant to these lifestyle modifications, research proposes a decrease in blood pressure and risk for future cardiovascular disease.
Nursing interventions suggested in the literature include engaging in a healthy lifestyle including diet management, weight control, and exercise. As stated before, diet management regarding patients diagnosed with hypertension is crucial for preventing further decline. A.D. has been practicing diet management for the previous two years and currently states that he “tries to cut down on sodium and consume foods that promote healthy blood pressure”. From the time of being diagnosed with hypertension to now, A.D. has lost 30 pounds from diet management and exercise. A.D. currently weighs 228 pounds and is 6’1”, giving him a BMI of 30.1, which is obese. Although he is considered obese, A.D. plans to lose more weight in the future through the same type of healthy lifestyle. In addition to diet management and weight loss, A.D. regularly goes to the gym about three times a week. His current gym regimen involves him doing cardio and weights every time he attends. A.D stated, “I try to incorporate cardiovascular and weight training exercises into my workout”. Cardio either being the bike machine or treadmill, and weights involving body weight exercises or free weights. A.D. also stated that he plans to continue his exercise routine throughout the future to promote losing weight and preventing further decline.
Direct nursing care measures and patient teaching which have been utilized with A.D. was educating on exactly how to engage in a healthy lifestyle required to prevent further decline of hypertension. Instilling different types of diet management and emphasizing the importance of prioritizing diet management are essential for patient competence. This may include describing different dieting plans or explaining specifically what foods to avoid and what foods to prioritize in a diet geared towards those who are diagnosed with hypertension. The importance of weight loss in addition to diet management is essential to educate the patient on, due to its positive effects on lowering blood pressure and therefore reducing the risk of worsening hypertension. Further education on integrating exercise into someone’s life is also important when teaching a patient how to engage in a healthy lifestyle. Explaining outlets for working out and the variety of at home exercises is important regarding a patient who may be overwhelmed with the idea of working out in general. As well as explaining how to engage in a healthy lifestyle, it is crucial to educate the patient on how hypertension has the potential to turn into serious cardiovascular disease. This may prompt the patient to prioritize preventative measures more seriously. Literature suggests that with diet management, weight loss, and regular exercise, a patient’s blood pressure is likely to decrease, reducing the potential of their hypertension to turn into serious cardiovascular disease.
A.D. is receiving the best practice based on the evidence that literature indicated, yet more education on specific diet management could be given. Further education would be given to confirm that he is getting the nutrients that he needs while only ingesting foods that promote cardiovascular function.
Developing a teaching plan for this patient would include mapping out a specific diet management plan and weekly exercise regimen. As stated before, A.D. currently “tries to cut down on sodium and only eat foods that promote healthy blood pressure”. Although this statement indicates that A.D. prioritizes a heart healthy diet, providing a specific diet plan would be beneficial in creating structure and therefore increasing compliance. Proper nutrition should include a diet high in fruit, vegetables, legumes, whole grains, and low-fat dairy. This will ensure that A.D. gets the appropriate vitamins and minerals needed, yet also promoting healthy blood pressure. A key exercise regimen would include cardio and weight bearing exercises for a period of 30-60 minutes three times a week. Cardio would involve biking or running, and weight bearing exercises may include either body weight, or utilizing free weights. These dynamic range of aerobic, dynamic resistance, and concurrent exercises will allow the burning of fat in the body, which lowers blood pressure, in addition to strengthening muscles. The limitations of this teaching plan would be noncompliance from the patient. As healthcare workers, educating the patient is vital in preventing decline, yet it is ultimately up to the patient whether or not they choose to comply with the teaching plan. Appropriate related nursing diagnoses would include knowledge deficit related to lack of specific diet plan. Due to not being prescribed a strict diet plan, this results in lack of in dept knowledge of which foods to avoid and prioritize for proper nutrition.
To evaluate the effectiveness of this teaching plan, A.D. stated that he plans to check his weight every day at the same time each day and monitor his blood pressure to assess any changes. A.D. agreed to prioritize a structured diet regimen and frequent exercise to continue to lower his blood pressure. In the future regarding nutrition, A.D. plans to discontinue red meats, alcohol, and sugar from his diet. He also states that he will incorporate cardiovascular promoting exercises that specifically burn fat into his exercise plan. The effects of these strategies will therefore be monitored through the evaluation of his body weight and blood pressure. Strengths to this teaching plan include that A.D. was educated on exactly how to engage in a healthy lifestyle involving proper nutrition, promotion of weight loss, and exercise. He was also educated on the importance of prevention of further cardiovascular disease. Another strength is that he was given structured diet and exercise plans in attempts to increase compliance.
Some suggestions in the literature that can be used, as a nursing student, to change practice would be to familiarize yourself with proper nutrition and exercises regarding patients diagnosed with hypertension. Understanding what foods inhibit the promotion of healthy blood pressure and which foods and exercises benefit those with high blood pressure is crucial when educating about controlling blood pressure. 
The patient’s preferences, with regard to the care given, are to continue with his diet and exercise plan. A.D. states “I want to continue to avoid sodium and only eat foods that promote healthy blood pressure. I also want to continue to workout three times a week and keep up the exercises I do at the gym.” The patient has been improving his compliance to following the teaching plan given and continues to show improvement in his blood pressure and weight loss.
Summary Conclusion
Nursing responsibilities in caring for patients affected by hypertension involves providing the best holistic personalized care while educating the patient. Holistic care entails more than solely dealing with the physical aspect of hypertension. To help patients appropriately cope and manage this condition, nursing responsibilities include taking into consideration the psychological, social, and spiritual aspects that the patient may be dealing with. Patients diagnosed with hypertension also need individualized care, which impacts wellness and promotes the best outcome for their situation. This means providing education on specific diet and exercise plans available to the patient and encouraging compliance with those plans. Education and encouragement are vital factors that contribute to impacting patient compliance. As nurses, offering these attributes to care endorses an overall well experience when patients are working through a chronic illness or condition.
References
Jones, N. R. V., Forouhi, N. G., Khaw, K.-T., Wareham, N. J., & Monsivais, P. (2018). Accordance to the Dietary approaches to stop hypertension diet pattern and cardiovascular disease in a British, population-based cohort. European Journal of Epidemiology, 33(2), 235–244. doi: 10.1007/s10654-017-0354-8
Mohamed, S. F., Mutua M. K., Wamai R., Wekesah F., Haregu T., Juma P., … Ogola E., (2018). Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in kenya. BMC Public Health, 18(3), 9–19. doi:10.1186/s12889-018-6052-y.
Pescatello, L. S., MacDonald, H. V., Lamberti, L., Johnson, B.T. (2015). Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Current Hypertension Reports, 17(11), 1–10. 2015. doi:10.1007/s11906-015-0600-y.
Poorolajal, J., Hooshmand, E., Bahrami, M., Ameri, P. (2017). How much excess weight loss can reduce the risk of hypertension? 95–103. Journal of Public Health, 2016. doi:10.1093/pubmed/fdw077.
Sanuade, O. A., Boatemaa, S., Kushitor, M. M., (2018). Hypertension prevalence, awareness, treatment and control in ghanaian population: evidence from the ghana demographic and health survey. Plos One, 13(11), 1–19. doi: 10.1371/journal.pone.0205985.