First Eat Right - Dietitian Nutritionist Dr. Nafeesa's Diet & Nutrition Clinic

Health is the ultimate requirement of any human being. Its beyond what money, power or position can buy you! Good health is the result of a healthy lifestyle, nutritious foods and a stress-free living. There is no substitute for health and we cannot replace ourselves with a substitute who can work for our health! ‘Earn your health by learning to stay fit’ is 100% true and in this world, individuals have started realizing its true value with the occurrence of more and more obesity/overweight-related issues that’s taking each of us by storm. Consumers have become extremely health conscious wanting to choose foods and ingredients that are rich in nutrients. They are curious to know how their intake of foods would affect their health and fitness goals and hence, are ideally interested in knowing the nutritional value of the food they consume. With the advent of fitness devises and online activity trackers consumers keep constantly updating themselves on their recent activity levels, heartbeat rhythms and overall fitness ratios. Many are in love with fitness wearables and don’t hesitate to spend thousands of rupees on these wearables that use accelerometers, GPS tracking and other technology to track the activity level.

Some others stick with their traditional approach of maintaining a diary to note down daily intakes. Its good, works wonders on our rote memory and also makes us realize the number of calories that goes into our body each day. This might even make us more aware of what we choose to eat and avoid. But maintaining a diary is time consuming, needs us to exactly remember how much we ate, what we ate and when we eat which is bound for errors, requires our manual input daily, leads to under- or overestimation of what we eat and above all, we are bound to get tired of the daily task of updating our diary thereby abandoning the idea altogether and skip the noting down part. This is especially true in case of consumers who eat out at restaurants who are burdened with the need to track and know the ingredients and the amount of ingredients that go into a meal. Many restaurants these days denote the nutritional information of the different foods offered in the menu card or even their websites show the required information but the individual still is forced to pen down this information manually in his/her diary which is time consuming and takes greater efforts. These consumers would be overjoyed when they have a system that would automatically calculate the caloric intake and nutritional values of their meals including when he/she is eating at a restaurant.

The patent here talks about the invention of a health tracking (HT) computing device to retrieve nutritional information for a consumer. It includes receiving transaction data associated with the transaction of the consumer. This transaction data includes transaction amount and a merchant identifier associated with a food merchant. There are all the different combinations possible for the food amount listed and the nutrients linked to each food is also noted. As soon as the consumer swipes his/her card the transaction data involved starts rolling out the process of information extraction. The HT computing device also generates recommendations for healthier food items available at other different merchants based on the stored nutritional information available in the database corresponding to the payment cardholder. As the location of the consumer is also received along with other information in the transaction data, the system generates recommendations based on the available options that exist in the nearby locations from where the consumer is currently present.

The price of each item and menu information are queried from a database and this information is used to compare the transaction amount of different food combinations that total the transaction amount. For instance, a food item might contain nutritional information including calories per dollar for the price of the food item. The different nutrient suggestions, possible nutrient combinations, suggestive food options and locations of healthy food are a great help for the consumer who wishes to choose healthy foods for his/her meal. The patent was published on 22/6/2017 and for in-depth information on the patent please check out the following links:
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United States Patent & Trademark Office: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=3&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=144&f=G&l=50&co1=AND&d=PTXT&s1=health&s2=fitness&OS=health+AND+fitness&RS=health+AND+fitness
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World Intellectual Property Organization: https://patentscope.wipo.int/search/en/detail.jsf?docId=US199419841&redirectedID=true

European patent Office: https://worldwide.espacenet.com/publicationDetails/biblio?DB=EPODOC&II=0&ND=3&adjacent=true&locale=en_EP&FT=D&date=20170622&CC=US&NR=2017178534A1&KC=A1
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A woman’s health goes for a toss at different stages of her life owing to the staggering hormone imbalances that are prominently seen during her puberty, childbirth, monthly menstruation cycles and post-menopause. Hormones define our moods and energy levels. The efforts required to go through a smooth transition through our younger years with these hormone fluctuations is passable when we compare the changes that occur to our physical and mental well-being post menopause. Speaking of the physical body, osteoporosis affects the health of postmenopausal women making it a great cause of public concern worldwide.
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Osteoporosis: Porous Bones
Our bones become stronger and bone mass increases only until the age of 30 after which it starts deteriorating. The quality of our bones is directly dependent on the quality of the food that goes into strengthening our bones until the age of 30 after which the food we eat helps to only maintain the nurtured strength and bone mass until menopause. After menopause there is a sharp drop in estrogen levels leading to greater bone loss paving way for conditions such as osteoporosis. Bone loss happens at a rate of 2-3% during the first few years and 0.5-1% thereafter. Osteoporosis is a progressive disease characterized by a decrease in bone mass and deterioration of bone structure leading to an increased risk of fragility fractures. The causative factors are many-genetics (almost 60%) takes a blame on one side for bone metabolism while nutrient intake takes the blame on the other end of the spectrum. We are well aware that vitamin D and calcium are integral to a healthy bone structure but other micronutrients and vitamins too are critical for a smooth bone metabolism. Despite genetics playing a more-important role in deciding bone mass variance, by adopting a heathy lifestyle that increases peak bone mass in kids and adults we can reduce the risk of osteoporosis.

Dairy products have been lauded with benefits for supporting better bone mineral density (BMD) but there are also controversies surrounding their protection against osteoporosis. A population study showed that consuming 300 mg/day of calcium (one glass of milk) decreased risk of hip fracture in postmenopausal women whereas a Swedish study showed that consuming three or more glasses of milk/day increased the risk. Meta-analysis too showed that decreased milk intake was not associated with increased osteoporosis risk. These studies are from the West where the diet is enriched with abundant cheese and yogurt intake. Comparatively, the consumption of milk and dairy in Asian countries is pretty less and we need studies exploring the effects of dairy consumption on osteoporosis risk in postmenopausal women in these countries.

The Korean Study
While fermented foods are an integral part of every Korean household along with rice and vegetables, the importance given to dairy products is not up to the mark-only 60% (479 mg) of the recommended dietary allowance of calcium (800 mg/day). Also, the prevalence of osteoporosis among Korean women was more than double that of American women which makes the study regarding the effects of dairy on osteoporosis in countries that consume low milk and dairy products even more critical.

The cohort Korean study initially included 10,038 participants aged between 40 and 69 years of which 2,317 completed their food frequency questionnaire at the baseline survey. After elimination and withdrawals only 1,573 participants remained for analysis and a dietary intake assessment was made on these participants where the dairy foods included mostly were milk, yogurt, cheese and ice cream. The frequency of servings was split into 9 categories-never, once a month, 2-3 times a month, 1-2 times a week, 3-4 times a week, 5-6 times a week, once a day, twice a day and three or more times a day. Portion sizes were classified as small, medium and large. Height and weight measurements, age of menopause, lifestyle routines, exercise routines, smoking and drinking behaviors and body mass index calculations were done for each of the participants.

In the four-year follow-up period 273 new cases of osteoporosis in the radius and 407 in the tibia were identified. While smoking and physical activity did not differ between the two groups, people in the osteoporosis group were found to have higher BMI, lesser education, lower household income and living in a rural area comparatively. The radius osteoporosis group had decreased intake of milk, yogurt and dairy products in comparison to the normal group. Results showed that:

1. More frequent that an individual consumes dairy, lower was the incidence of radius osteoporosis
2. More frequent that an individual consumes milk and yogurt lower was the risk of radius osteoporosis
3. Consumption of milk, yogurt or cheese did not show any reduction in osteoporosis risk in the tibia
4. Postmenopausal women who consumed dairy products more than once daily were at a lower risk of osteopenia compared to those who consumed only 2-3 times a month which shows that higher the frequency of consumption lower is the risk of osteoporosis.
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While the Korean study clearly showed the benefits of dairy only on the radius and not on the tibia, the Finnish study and another population study too shows that high calcium intake was associated with a positive effect on the radius and not on the tibia.

A 10-year Chinese cohort study showed that when calcium intake was <400 mg/day it proved to be a prominent risk factor for hip osteoporosis in postmenopausal women. Another study found that calcium supplements decreased bone mass loss in women who have been in their post menopause stage for more than 5 years. A cross-sectional study performed on 1,771 early postmenopausal women showed that calcium intake was never a problem for osteoporosis risk when overweight was not considered. Taking overweight into account it was found that women with the lowest calcium consumption was likelier to have osteoporosis compared to women with the highest calcium intake. A small change in dietary practice that promotes calcium intake could be of great help in reducing the risk of osteoporosis in postmenopausal women. In another study, 30 healthy postmenopausal women were either given 500ml of semi-skimmed milk increasing total calcium to 1,200 mg or were given no supplementations. At the end of the 6 weeks of trial those who received supplements had a decrease in several biochemical variables compatible with diminished bone turnover.

Many studies also show that lower milk intake during childhood was a critical factor in causing osteoporosis in later adulthood in women. There are several other studies that show that intake of vitamin D and calcium proved to be a rockstar combination in reducing the risk of osteoporosis in postmenopausal women.

European Study
Even European data show that intake of vitamin D and calcium was below recommended ranges in postmenopausal women and this might be debilitating for bone health. Women aged 50 and above took anywhere between 600 mg/day to 900 mg/day which was below recommended ranges but the surprising fact here is that even younger adults lacked the necessary levels of these nutrients. A survey by the International Osteoporosis Foundation (IOF) showed that 60% women knew that they were at an increased risk of developing osteoporosis at some point in their life and 99% respondents realized the importance of calcium for improved bone health.

Comparative Cross-sectional Study
A study on 60 women who were over the age of 50 and were postmenopausal for over 5 years was conducted for analyzing the risk of osteoporosis. These women were split into two groups-the control group consisted of 30 women with a T-score at the lumbar spine or hip to the upper 1 and group case consisting of 30 women with osteoporosis with a T-score at the lumbar spine or hip equal to -2.5.

Body measurements were taken, a food questionnaire was given asking for food consumption frequencies of different foods in the last 10 years, overall caloric intake and the major nutrients that were normally consumed. A questionnaire consisting of 20 items that matched the majority of foods were grouped into 6 groups-milk and dairy products, meat, poultry, fish and eggs (MPFE), fruits and vegetables, legumes and starchy foods, drinks such as coffee, tea and soft drinks, oil seeds and olive oil.

The average calorie intake was similar in both the groups while protein intake was in excess and fiber intake was below recommended levels. The average calcium intake was significantly lower in the osteoporotic group compared to the control group and so was potassium intake. Intake of copper, magnesium, phosphorus and vitamin D was also significantly lower in the osteoporotic group compared to the control group. Milk and dairy products consumption were also significantly lower in the osteoporotic group but meat consumption (MPFE) was higher in women in the osteoporotic group. With respect to fats, while saturated fat intake was higher the consumption of monounsaturated fatty acids was significantly lower in the osteoporotic group.

Nutrition is a prominent determinant of osteoporosis and the greatest risk factor for osteoporosis in women above the age of 50 is menopause. It is possible to combat this risk with the right intake of nutrients such as calcium, vitamin D and protein, exercising regularly and abstaining from drinking and smoking. Dairy products provide us with more of these nutrients comparatively. A glass of milk, a 180 g serving of yoghurt and 30 g of cheese gives you with 250 mg of calcium. So, it is possible to achieve daily recommendations with only 3-4 portions of dairy but if you try achieving it with vegetables or whole grains you need 24 servings of green veggies or 48 servings of whole grains to accomplish the same. By eating a well-balanced diverse diet, we can fulfill the nutrient needs of our body and keep it healthy.

References
High dairy products intake reduces osteoporosis risk in Korean postmenopausal women: https://e-nrp.org/search.php?where=aview&id=10.4162/nrp.2018.12.5.436&code=0161NRP&vmode=FULL

Dairy intake & bone health: https://www.sciencedirect.com/science/article/pii/S0022030211005522

Nutrition & bone health in women after menopause: https://journals.sagepub.com/doi/full/10.2217/WHE.14.40https://journals.sagepub.com/doi/full/10.2217/WHE.14.40
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Nutritional risk factors for postmenopausal osteoporosis: https://www.sciencedirect.com/science/article/pii/S209050681630015X

Most of us are members of the ‘clean plate club’ as that’s the way we’ve been brought up since younger age-finish off whatever has been served onto the plate irrespective of the size of the plate. Mama and papa even bribe us with candies or ice creams to eat our food. Disciplining the kid to complete his/her meal is not the right way to teach him/her portion control. By dictating this way, we are nurturing a generation of children who remain unaware of the portion sizes that would keep their stomach full. When our child says that his/her tummy is full its time to say goodbye to the rest of the food. Only by doing this we allow them to decide upon the right quantity of foods that would satisfy their hunger. If not, the child grows into an adult who eats all that is in his/her plate irrespective of whether he/she is hungry or not. Portions are integral for our weight management. How much we eat is a key player in assessing our total calorie intake beyond what we eat.
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The amount of food served determines the amount of food usually consumed. And, the amount of food served depends on the eating ware placed in front of you during mealtime. Despite this, we remain unaware of the fact that a simple eating ware dominates our portion sizes and the rate at which we eat our food. The edge of the container is the maximum space allocated for filling it. Solid foods can even exceed the rim of these containers and we don’t have any measuring system that takes this into account for total calorie calculation. When you go to a nutritionist or dietitian for a diet chart, the RDN gives you a list of foods that can/cannot be eaten along with portion sizes. At the nutritionist’s clinic, she shows the respective portion sizes allowed and the measures that denote these portion sizes. The portions recommended (based on your age, sex, weight, etc.) differs from what you’ve been consuming until now. This is hard to put into practice for anyone of any age as currently there are no recommendations to gradually modify the rate and quantity consumed neither are there any tools to guide the user in this process.

Many start to diet thereby drastically cutting out portions and finally end up binge-eating owing to lack of fullness and satiety. A lot many diet devices focus either on the fat, sugar and calorie content of the food or individual serving containers. Individuals are also unaware of the subtle differences in eating ware that can cause a pile up of food portions at the end of the day. For instance, a plate is a plate but the depth of the plate decides the quantity of food that goes into the body. A plate with more depth can contain more food than a flat-surfaced plate. The devices used mostly help in measuring food contained within the device and does not bother about the consumption processes as a system. The individual also assumes portions by making a judgement of the size of the eating ware and the foods served onto it.

Weight loss that happens over a period of time is healthy and stays long. Lifestyle changes and eating habits must be changed gradually to maintain permanent weight loss. Apart from changing what goes into our plate we also need to completely focus on how much of it goes into our plate. Rather than abruptly bringing in changes it is required to make a gradual process over time. The rate at which you eat the food also determines how much food you eat. Sitting down at the dining table, its impossible to keep your dieting routine discreet as the devices currently used are sure to make others look not once or twice but a many more times in your direction.

The patented eating-ware device invented here relates to an incrementally-sized standard-sized eating-ware system processed for weight management and uses multiple formulas to design and establish certain standard sizes for eating wares which are used as measures to control the amount and rate of food consumed for weight management. This incrementally sized standard-sized eating-ware system enables the user to directly eat from the eating-ware rather than measuring it or transferring it into some other utensil. No devices until now have established standard portion size (SPS) and standard snack size (SSS) and none have addressed the importance of standard size of the utensils and utensil-like eating-ware components using standard bite size (SBS) and standard nibble size (SNS) which determine the rate at which we consume foods. Many snacks come in prepackaged sizes and there would be no need for these measuring devices as the user can directly eat from the packet. But, SNS, SSS, SPS and SBS can be assigned to any prepackaged foods to help the use stick to portion sizes and stick to his/her weight without having to empty the packet into another container. The SNS and SBS are of great help here as we have not got any device helping us measure the quantity of food that goes into the mouth nor we have any idea to calculate calories based on this quantity.  The eating-ware component’s geometry can be circular, oval, polygonal or likewise and it can be anything like a bowl, plate, drink-ware or any item that can be used to transfer food directly to user’s mouth or any item that can be used to serve and eat food directly and it can be oval, square, polygonal, cubic or cylindrical. The patent was published on April 28th, 2016 and occupies pivotal importance due to its advantage in our day to day life and weight loss efforts. If you would like to know more about the patented device you can always visit any of the referenced sites here for further understanding.

References
United States Patents & Trademark Office: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=%22%09HIGHET+DANUTA%22&OS=%22
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European Patent Organization: https://worldwide.espacenet.com/publicationDetails/biblio?II=0&ND=3&adjacent=true&locale=en_EP&FT=D&date=20160428&CC=US&NR=2016117950A1&KC=A1
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World Intellectual Property Organization: ​https://patentscope.wipo.int/search/en/detail.jsf?docId=US162049442&recNum=1&office=&queryString=%09HIGHET+DANUTA&prevFilter=&sortOption=Pub+Date+Desc&maxRec=8

Chubby cheeks and dimple chin are loved in babies and in course of time when the chubby baby grows up, what do we expect of from him/her-to become fit from within? That’s not fair! Fitness, exercise and healthy lifestyle are not habits that are introduced at a specific age in life but must be incorporated into the lives of children right from an early age and there is no base age limit for this! Some think that it’s a curse for the present generation to grow in a restricted lifestyle right from a tender age but alas this is the generation that feasts on juicy burgers and delicious pizzas too thereby jeopardizing their health and making childhood and adolescent obesity a major epidemic. In 1997, the World Health organization declared obesity as a global epidemic and almost more than 10% of the children aged between 5 and 18 years are obese/overweight globally. There has almost been a 50% increase in obesity rates in boys and girls between 1980 and 2013. Fitting into modern clothing and dressing up might be a concern due to weight issues among adolescents but there’s more trouble for the mind and body from a health perspective. Type 2 diabetes mellitus, insulin resistance, hypertension, sleep apnea, poor self-esteem, isolation and a lower overall quality of life (health-wise) are common in obese/overweight children. Statistics are clear and the measures that need to be implemented are also crisp but the major point here is how do we implement the measures and what do we do to overcome the epidemic.
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Think, Let the Ideologies Sink
Almost 80% of obese adolescents continue to grow into obese individuals in their adulthood. Adolescence is a period of rapid growth where numerous hormonal changes occur in every individual’s body. This is also the period for the development of obesity and curbing this hazard by bringing in appropriate interventions lays a concrete platform for a lifetime of healthy lifestyle practices that favors the individual for a lifetime of good health. Physical activity is said to be a feasible intervention as children play outdoors (assumingly!) and bringing in changes to their game plan to increase exercise duration is way better than restricting their food portions, limiting a huge list of foods and preventing them from eating out. Healthy eating practices are essential but they alone are not sufficient for radical changes in health.

Fitness tests shock us with the result that children today weigh more and have more body fat compared to their counterparts 30 years ago. Motivating your child to start exercising has the potential to decrease the risk of cardiovascular disease (CVD) and also improve heart health. While it is generally assumed that kids are active naturally and don’t need an external push/factor to keep them active many children today are used to a sedentary lifestyle due to the society- smartphones and television shows lure these kids away from playing in the ground to being locked up inside a room all day. Outside factors such as living in a nuclear family where both parents work and the child is left in a daycare, absence of someone to help the child play out, living in an apartment and unsafe neighborhoods support sedentary lifestyle, promote obesity rates and also are risk factors for asthma, diabetes and hypertension.
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Worldwide Studies on After-school Exercise Effects on Adolescent Children
In USA, 1 in 5 children aged around 15 years has a 1 in 5 chance of having clinical symptoms of coronary heart disease. China too has witnessed a steady rise in obesity rates in the past couple of decades. A Chinese research studied the effects of after-school physical activity with/without diet restrictions on obesity, fitness rates and metabolic profiles in obese/overweight Chinese adolescents.

93 overweight adolescents aged around 13-15 years and whose BMI was between 22-35 were considered for the study. Each of these participants were randomly assigned into one of the four groups-diet, exercise, diet & exercise and overweight control. Diets were planned as per the individual’s body weight and age, one hour of exercise session happened four times a week after school hours and this schedule continued for 10 weeks. All the groups except for the overweight control group witnessed a significant decrease in BMI rates, body fat percentage and waist circumference. So, performing exercise at least thrice a week had a positive impact on central adiposity and overall weight ranges on these Chinese adolescents.

Indian Study on Adolescent Obese Boys
Until now there are not many intervention studies in India for managing obesity problems and most of them come from the West and these studies are based on school-based approaches as more than 90% of the adolescent children attend school making it one of the finest way to attain your goals. A study in India on adolescent boys (studying in class 5-10) aged between 9 and 15 years was conducted. Measurements such as height, weight, body fat, waist circumference, skin fold measures and blood pressure were noted down.

The after-school exercise session happened five days a week for 10 months and every session was for a period of 60 minutes. The session was clearly planned in this manner: session commences with warm-up and stretching activities, then comes cardio and strength training and finally, a period of cooling down activities. Sometimes, sports were also a part of the exercise sessions as it helped the individual perform moderate-intensity activity during the period. After the study period (148 sessions) the study measures were calculated and the data compared.

Recommendations are for 30 minutes of moderate-intensity exercise at least thrice a week (accounts for 450 min of activity every month) and the participants were divided into three groups based on exercise interventions. This study enforces a 50 min session and when the participant attends 9 sessions (90 sessions in 10 months) the stipulated 450 min of activity time is reached. Any person who attended less than 90 sessions was categorized into low participation group, those who attended 120 of the 148 sessions were categorized into high participation group and those attended between 91 and 119 sessions belonged to the moderate participation group. Of the 205 participants involved in the study, 24% had low participation, 33% had moderate participation and 43% had high participation. Results showed that:

1. Weight increase was comparably less (2 kg) in the high participation group compared to the low participation group (4.1 kg) but increase in height was comparable in both the groups.
2. While BMI did not have any significant variations, there was a significant decrease in body fat (1%) in the high participation group
3. Kids in the high participation group had significant reduction in triceps skin-fold and biceps skin-fold
4. Waist circumference, sub-scapular skin folds and supra-iliac skin folds-indicators of central adiposity did not show much difference at baseline but during follow-up, the low participation group showed significant gain in all three central adiposity indicators while high participation group showed significant decrease in these parameters.
5. TV viewing is linked to decreased physical activity participation, increased sedentary time and also increases the consumption of high energy foods. Those with high participation levels in physical activity and exercise showed a significant decrease in time spent in sedentary lifestyle, TV viewing and more.
6. Physical activity interventions after school helped in reducing adiposity and overweight rates among adolescents who participated in 12 sessions of 50 minutes of activity per month which comes to 3 sessions of activity per week. This brings us to the recommendation of at least three sessions of 50-minute activities every week to keep our kids in healthy weight ranges.
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During & After School Hours
Making PE compulsory in schools is a great initiate but that’s alone not sufficient to curb the obesity epidemic. A 2-year study showed that children who had increased physical education and modified PE classes experienced greater physical activity during school hours but these kids showed poor after-school activity routines and there was also no improvement in fitness or body fat percentage in them. Many other researches also show that involving in 30-60 minutes of physical activity outside school hours leads to overall improvement in physical activity levels, especially in kids.
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While younger children are motivated to involve in free play, sports such as swimming or football and engage in walking for a moderate distance that’s tolerable, children nearing puberty (12-12 years) can be allowed to take up a sport or even do weight training under adult supervision for a limited period. Adolescents can involve themselves in sports, doing household chores, yoga, running, dancing or even active transportation (such as walking and cycling).

References
A Randomized Control Trial of Chinese Adolescents: https://www.ncbi.nlm.nih.gov/pubmed/21362327
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Effects of After-school Physical Activity Intervention to Reduce Obesity Among Indian Adolescent Boys: http://www.foodandnutritionjournal.org/volume1number1/effects-of-after-school-physical-activity-intervention-to-reduce-obesity-among-indian-adolescent-boys/
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Prevention of Childhood Obesity through Increased Physical Activity: https://pediatrics.aappublications.org/content/pediatrics/117/5/1834.full.pdf