Cornelia-Aurelia Zugravu
Department of Fundamental Sciences, Faculty of Nursing and Midwifery, “Carol Davila”
University of Medicine and Pharmacy Bucharest, Romania
Correspondence to: Cornelia-Aurelia Zugravu, MD, PhD, Associate Professor, Nutrition and Hygiene, dr_corinazugravu@yahoo.com
Abstract:
The link between nutrition and chronic non-transmittable diseases has been intensely studied in the literature, appearing that weight management and nutritionally rich food ingestion have a positive effect on preventing or delaying the occurrence of chronic ailments such as obesity, which is a well-known risk factor for cardiovascular injuries, diabetes and even cancer. The main issue could be the fact that the relationship with food is not only for survival and ensuring fuel for the body; nowadays, it has social or even personal significance, which leads to an unbalanced association with the healthy purposes of eating, that can have critical pursuits in the long term. Our mission as doctors is to encourage a healthy lifestyle, educate patients regarding the benefits of rigorous nutrition, and promote prophylaxis through the nutrition of chronic non-transmittable illnesses.
Keywords: nutrition, chronic non-transmittable disease, diabetes, myocardial infarction, cancer
One of the most important elements of the human ecosystem is represented by food. Talking about food and its prophylactic function, primary or secondary, is a very complicated subject. And this is because our relationship with food is extremely complex, and often the factors that intervene in choices and consumption are subjective and may seem illogical. Of course, food has a basic energy-plastic function, on which many studies are done, but the relationship between food and hedonic and cultural, ethnic, and social elements should not be neglected. Who can consume foods proven to be unhealthy? Well, anyone. Especially when we are dealing with a gray area, where there is no exclusively bad food and exclusively good food. Such confusion related to choices “that harm us” may be natural for nutritionists, but not for patients. In the context of food abundance, man is determined to choose food to a lesser extent due to physiological needs and more determined by appetite, social context, the pleasure caused by food, the memories caused by the ingestion of a certain type of food or the fact that choosing a particular product makes him declare his membership of an ethical or religious group or display his social success. Hence the almost insurmountable problems that doctors encounter when trying to change an individual’s eating habits. And the methods, sometimes bordering on ethics, to make the patient improve his diet. References to physical appearance are often more directly motivating than references to hypothetical future diseases to which unhealthy eating can contribute. Because isn’t it, nobody gets seriously ill tomorrow from what they ate today, except maybe from food poisoning.
The species has adapted us perfectly to shortages, to hunger, we instinctively accept fatty and sweet foods that bring a lot of calories, because primitive man did not know when the next meal would be and wanted as much energy as possible when he had access to it. Today the meal is over... two hours or whenever we want, but the phylogenetic influences are very difficult to control. Let’s add to this extremely complicated framework genetic and epigenetic influences, studies whose conclusions are contradictory, and social media that take distorted messages from the scientific media, and we will better understand why nutritional strategies are difficult to develop.
It is still essential to pay special attention to nutrition. And I am specifically referring to the role of nutrition in prophylaxis. Because today, in a world that has 537 million people with diabetes mellitus, and in which the obese will probably reach one billion in 2030 worldwide, in which the World Health Organization says that not even in Europe it was possible to stop the galloping increase in number of overweight people, in a world where the main killer is non-communicable diseases, nutrition appears to us as a basic pawn. Nutrition occupies such an important place today precisely because it is a compartment that can be modulated, even if not easily, as I showed previously. Although its correction does not ensure the solution to all problems, practice shows that even in obesity it cannot be used in isolation, nutrition can help us with an enormous number of ailments, as more and more complex studies prove.
I previously mentioned chronic diseases, the basic enemy of modern man. They are always pluri-etiological conditions and among multiple determining factors we regularly find nutritional factors. This does not mean that nutrition, alone, can always remove the appearance of the disease or its evolution. We are dealing with circumstances that have many actors, but basically, it is useful to intervene as little as possible. Can the doctor guarantee the patient that if he stops eating saturated fats in exaggerated quantities, he will avoid vascular accidents or myocardial infarction?! Of course not. But the chances of getting these diseases to decrease. Maybe not by much, but even a relatively small risk can mean the difference between life and death or between a normal life and a long life with a major disability. Things become even more complex in the case of neoplasia, a heterogeneous disease with multiple and often unclear determinism. Can food influence cancer?! Numerous studies say yes. Is it worth giving up gastronomic pleasures to reduce your probability of developing a neoplasia many years from now?! Here the answer can only be given by the interested person, but often they do not correctly assess the risks involved in inadequate nutrition. From my point of view, when we are talking about a group of diseases with such big implications, any behavioral and nutritional correction, no matter how small, can be useful even if it has a minimal contribution to cancer prevention.
It should also be emphasized that nutrition acts insidiously, both positively and negatively. Except for occasional accidents, such as indigestion or toxic infections, the effects of nutrition are seen in the long term. And because we were talking about cancer, a well-known cohort study showed that a certain type of diet can positively influence cancers, but the effects were manifested after... 14-15 years. It remains to be seen to what extent patients are willing to make long-term decisions, especially since many expect immediate results. No, foods are not short-term drugs. But their long-term effects, whether good or bad, are guaranteed by well-known studies, as well as by anecdotal knowledge. Of course, nutrition can also contribute to enviable longevity. Studies show that a modest caloric deficit, in the long term, can have this effect. Not everyone wants to become centenarian. I suspect, however, that they want to live all the years of their lives in health and comfort.
I think that it is our duty, as doctors, to use nutrition as a prophylactic factor, because science has not only confirmed that it can be useful, but also because we have succeeded many times in quantifying, in metaanalyses, this contribution, so that each to be able to make his assessment.
The years of disability caused by chronic diseases are very many and they contribute both to the substantial decrease in the quality of life and the emergence of complex economic problems at the individual level and the level of health systems. Why wouldn’t we use nutrition then? Frequently, the practitioner himself forgets it, devoting himself to medicinal treatments. Of course, these should not be set aside. But an integrative approach is extremely useful and sometimes minimal dietary changes can bring major prophylactic advantages.