So you've signed up for this nutrition class and you're obviously interested in nutrition.

But what are some of the reasons why it's important to study nutrition? That's what we'll cover in this lecture. We make choices everyday that affect our physical health and our mental well-being. The choices that we make independently maybe insignificant by themselves, but if you couple them with other factors over a period of time, that essentially determines our health profile. So what you can see here from the slide, is that, if you choose a proper diet plus a positive lifestyle, the end outcome is you will achieve wellness. On the flip side, a poor diet with negative lifestyle factors will lead to death and disease. Did you know that 65% of the world's population live in countries where overweight and obesity kill more people than underweight? A lot of people are surprised to learn that. If you think about the whole world, you would think there's probably more underweight and starving people than there are overweight and obese people. That's actually not the case anymore. The tide has certainly changed in the last couple of decades and we know now that there are more people who are overweight in the world than there are people who are underweight. There are many costs to poor nutrition and not just costs as we talk about money. There's the cost being that poor nutrition leads to an increase for the development of chronic diseases. It also costs you, in the sense that you end up with a reduced quality of life and it does of course have a significant financial impact. In low income countries, the top causes of death tend to be related to infectioius disease. So if you look here, these are low income countries, things like lower respiratory infections, diarrheal disease, HIV and AIDS, and things like malaria, tuberculosis. There's certainly a little bit of chronic disease mixed in there, but for the most part, in low income countries, the burden of death pertains to or is caused by infectious as opposed to chronic

diseases. If you look at the high income countries, you can see things like ischemic heart disease. There is certainly dietary complications involved there, stroke and heart diseases, trachea, and different types of cancers, Alzheimer's, these tend to be not so much infectious, but rather chronic diseases. Here, we're looking at global, putting the rich countries and the poor countries together. Ischemic heart disease is still the number one killer. It counts for about 13% of all death around the world. And, that's one of the reasons why we're going to spend a good amount of time in this class looking at the dietary choices that help either prevent or promote the various types of heart diseases. In rich countries, 2/3 of all people live to be greater than 70 years old, and they're going to die predominantly from things like chronic diseases such as cardiovascular disease, chronic obstructive pulmonary disease, cancer, diabetes, dementia. The things that are very complex and take perhaps an entire lifetime to develop. Lung infection is the only leading infectious cause of death that we see among people who live in quote unquote rich countries. Now, if you flip to the poor country side, only about 20% of a poor country's population will reach the age of 70. And greater than a 1/3 of all deaths will occur among children or adolescents who are less than 15 years old. And the primary difference here is that they're going to be dying of what are infectious diseases as opposed to the chronic diseases that you see in the wealthier countries. And as I mentioned, some of those infectious diseases include things like lung infections, diarrhea, HIV and AIDS tuberculosis, and malaria. We also see in predominantly poor countries that there is much death unfortunately attributable to the complications of pregnancy and childbirth. In the United States, I've highlighted a number of different diseases in red that have a direct correlation to dietary choices that were made or not made over the course of one person's lifetime.

In the U.S., as is the case in the whole world, the number one killer of people is heart diisease. The other conditions that are in the top 10 killers of Americans that have strong dietary implications include cancer. We know that there's a certain way that you eat that can help prevent against cancer and that people who have higher rates of cancer tend to have different dietary components, and we'll look at that over the course of this class. We look at stroke and cerebrovascular disease, there is certainly dietary implications there, and accidents, diabetes, and then a number of different kidney conditions. Some people ask, well, how can accidents and death from accidents be attributable to dietary decisions made over the course of ones life? And the reason why you see accidents, which, in the United States is the number 5 killer of Americans is because, many accidental deaths occur from motor vehicle accidents and the majority of motor vehicle accident death has alcohol in the equation somewhere and that is a dietary decision that one person in that equation, unfortunately, did choose to make. So if you add up heart disease, cancer, stroke, accidents, diabetes, and then the variety of kidney diseases, we can see that 30% of all death in the United States can be somewhat attributable to nutrition-related conditions. So that's why we study nutrition, because the choices that we're making today are affecting our health profile, not only today but in years to come, and may be playing a role ultimately in what we're going to end up dying from. Nutrition also affects the quality of life. As I mentioned, there are some of the costs, financial costs and we said quality of life is one of those costs. How can the way that you eat affect the quality of your life? Well, it impedes things like growth, improper diet leads to stunting and under development. Cognitive function, you'll learn when we talk about fats, that if you don't get the right mix or amount of dietary fat in the very critical earlier stages of life, your brain doesn't develop fully. As an adult, your ability to do physical and have work capacity is impacted by your nutrition status.

You know, if you go to work and you haven't had any breakfast, when you get hungry midmorning, if you're not focusing on your work you are focusing on your stomach crawling. Nutrition and quality of life are related because of course the choices you make now affect whether or not you get a disease or whether or not you are preventing a disease. And then, also our physical, our mental, and our social well-being are to some degree, tied to our quality of life. In the U.S., we know that rates of obesity have doubled since 1970 and we can't ignore this. It's certainly playing a role on the development of a number of these different chronic diseases that are killing Americans. There are some statisticians out there and some healthcare professionals who, based on their analyses have determined that for children in the United States, this is the first generation for which their life expectancy might actually be less than that of their parents. You never see that in a developing country, with the, in a developed country. rather With the advances in medecine, we tend to see people living longer, but because of the dietary choices that we're making today, our kids might actually live shorter lifespans than their parents did. This is a slide that comes from the Centers for Disease Control, and what it's showing you is the darker the colored states are, and we see these kind of clustered around the south of the southern part of US,well obviously, certainly a problem throughout the country, it's more remarkable in the southern parts of our country. And you can see that the orange indicates 30 to 35% of people in those states are obese, and we'll talk about what actually defines obesity. But if you looked at the slide 20 or 30 years ago, there was significantly less proportion of the population that was overweight or obese. So part of the discussion is not just oh, wow, the whole country is full of overweight and obese people, but how quickly we've gotten to this point, which compounds the problem. We mentioned the financial cost of

obesity? In 2008, obesity cost the United States approximately $147 billion per year. It used to, in '98, just make up about 6.5% of our healthcare. But by 2006, that number has jumped to 9%. Employers are concerned about the impact of overweight and obesity, because they're seeing that medical expenses for obese employees can be up to 42% higher than for those people who are healthy weighted. So even in financial sectors, banking, places that you don't usually think of nutrition, people are starting to pay attention, especially employers, because it's starting to cost them a lot. 21% of all U.S. medical spending right now is anticipated or thought to be related to obesity. When you think of the word malnutrition, what comes to mind? You probably think of something like a baby like you see here very, very underweight with the matchstick arms, the visible ribcage. That baby is certainly malnourished, but this guy over here, he's also malnourished. He doesn't look anything like the baby on the other side of this slide, but he's malnourished because he probably is consuming excessive amounts of calories and those calories, perhaps come from foods like potato chips and soda. He doesn't get enough calcium, he doesn't get enough vitamin D or fiber. He certainly doesn't get enough exercise. So, moving forward in this class, I want you to keep in the back of your head that malnutrition affects both, or pertains to both undernutrition and overnutrition. We know that proper nutrition is effective. As we said, this is an evidence-based course, and so some of the evidence has found that nutrition intervention has been proven to help reduce hospital stays. It's expensive to be in the hospital. So if a person can stay out of the hospital, we're going to save a lot both financially and quality of life-wise. That diet and lifestyle changes are cost-effective ways to treat a number of disorders, diabetes, obesity, disorders of lipid metabolism, and other chronic diseases. In these last few slides, I've provided a number of links.

If you don't know a lot about evidence-based practices, evidence-based medicine, or evidence-based nutrition, I want you to check these sites out, they'll give you a little bit of an overview. the first one is the Health World Organization has a fabulous new library called eLENA and that stands for the e-Library of Evidence for Nutrition Actions. You can see a list from A-Z and it involves conditions that both effect people in poor countries, in developed countries, or around the world. In the United States, we have something called the Academy of Nutrition and Dietetics and they've put together and Evidence Analysis Library. They also have a related mobile app, where you can download for your phone or your computer to learn about what evidence out there exists for different disease states. And lastly, in the United States, you, or, or around the world, you can access the USDA's, that the United States Department of Agriculture's Nutrition Evidence Library. And they use the data from this evidence library to set recommendations for people in North America for diet and for exercise. And lastly, you might consider checking out the United States Department of Health & Human Service National Guideline Clearinghouse. This is another place to find some good, solid evidence-based recommendations for diet and disease.