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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Textbook of Lifestyle Medicine
The Textbook of Lifestyle Medicine provides foundational knowledge essential to students and scientists across various disciplines to better understand this new area of research and practice. Incorporating the latest evidence-based research on the relationships between lifestyle factors and disease, this unique book discusses the practical tools necessary to address growing public health crises such as obesity, cancer, diabetes, and cardiovascular disease using a holistic approach to physical, mental, and spiritual wellness.
The book offers comprehensive and up-to-date coverage of how lifestyle medicine professionals can prevent and mitigate ‘Lifestyle Diseases’. Clear and accessible chapters explore modifiable lifestyle factors that positively affect health, nutrition, exercise, sleep, stress control, and social support, and highlight the negative impact of smoking, alcohol abuse, and other unhealthy lifestyles. Topics include sleep physiology, the genetic background and development of noncommunicable diseases (NCDs), the characteristics and principles of healthy lifestyle, the clinical significance of physical activity, and the mechanisms connecting social interaction and health implications. This important resource:
- Discusses the global burden and risk factors of the modern disease epidemic
- Covers a variety of nutritional approaches including the Mediterranean Diet and the Dietary Approaches to Stop Hypertension (DASH) diet
- Features in-depth coverage of the Mediterranean Lifestyle, a holistic approach to health and wellness
- Includes a clinical practice section and appendices on preventive medicine and public health tools and recommendations
- Contains key points, take-home messages, self-assessment questions, color artwork and numerous references, citations, internet links, and further reading suggestions
Written by two world experts in this growing field, the Textbook of Lifestyle Medicine is a must-have volume for students and practitioners in nutrition, exercise physiology, psychology, addiction therapy, sleep therapy, as well as physicians, nurses, and other health professionals wanting to expand their knowledge and practice.
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Seitenzahl: 841
Veröffentlichungsjahr: 2022
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Table of Contents
Cover
Title Page
Copyright Page
Dedication Page
About the Authors
Preface
Abbreviation List
UNIT I: Lifestyle Choices and Human Health
CHAPTER 1: Basic Concepts
Bibliography
CHAPTER 2: The Lifestyle Disease Epidemic
Genetic Background and NCD Development
Obesity: Epidemiology and Impact of Modern Lifestyle
Cardiovascular Disease: Epidemiology and Impact of Modern Lifestyle
Diabetes Mellitus: Epidemiology and Impact of Modern Lifestyle
Cancer: Epidemiology and Impact of Modern Lifestyle
Bibliography
CHAPTER 3: Components of an Unhealthy Lifestyle
Unhealthy Diets
Excess Caloric Intake
Saturated Fatty Acids
Trans Fatty Acids
Carbohydrates and Dietary Fiber
Foods and Food Groups
Dietary Patterns
Physical Inactivity
Unhealthy Weight
Tobacco Use
Excessive Alcohol Intake
Stress
Lifestyle‐Induced Epigenetic Alterations and NCD Risk
The Effect of Maternal Health and Lifestyle Habits During Gestation
Bibliography
CHAPTER 4: Characteristics and Principles of a Healthy Lifestyle
Bibliography
UNIT II: Healthy Diets
CHAPTER 5: Progression from Nutrients to Dietary Patterns
Focus on Single Nutrient Deficiencies
Foods and Food Groups
Holistic Approach to Diet; Dietary Patterns
Bibliography
CHAPTER 6: Popular Dietary Patterns Around the World
The Therapeutic Lifestyle Changes (TLC) Diet
The Dietary Approaches to Stop Hypertension (DASH) Diet
Vegetarian Diets
The Religious/Fasting Diets
The Healthy Nordic Diet
The Healthy Asian Diet
Bibliography
CHAPTER 7: The Mediterranean Diet
The Mediterranean Diet
The Emergence of the Mediterranean Diet
Deconstructing the Mediterranean Diet Pyramid into Its Primary Characteristics
Other Aspects of the Mediterranean Diet: Moderation and Frugality
Other Aspects of the Mediterranean Diet: Adequate Hydration
The Health Effects of the Mediterranean Diet
Quality of Life and Wellness
Mortality
Chronic Inflammation
Cardiovascular Diseases
Metabolic Syndrome
Dyslipidemias
Nonalcoholic Fatty Liver Disease
Hypertension
Type 2 Diabetes Mellitus
Cancer
Neurodegenerative Diseases
Chronic Respiratory Diseases
Mental Disorders
Autoimmune Diseases
Allergic Diseases
Bibliography
UNIT III: From Mediterranean Diet to Mediterranean Lifestyle
CHAPTER 8: The Mediterranean Lifestyle Paradigm
Conviviality and Socialization
Cooking Practices
Bibliography
CHAPTER 9: Physical Activity in the Mediterranean Region
Historical Perspective
Physical Activity: Definition, Terms, and Assessment
Global Health Implications and Trends of Physical Activity
Evolution and Current Trends in Physical Activity Recommendations
Physical Activity in the Mediterranean Lifestyle: History and Characteristics
Physical Activity in the Mediterranean Lifestyle: Clinical Significance
Bibliography
CHAPTER 10: The Need for Sleep and Its Effect on Health
The Chronicle of Sleep Research
The Need for Sleep
The Phases of Sleep
Mediterranean Lifestyle and Sleep Recommendations
The Effects of Sleep on Health
The Effect of Shift Work on Sleep Patterns and Health
Bibliography
CHAPTER 11: Social Life, Spirituality, and Stress Management
Sociability and Social Ties
Social Interaction, Quality of Social Ties, and Health Impact
Mechanisms Connecting Social Interaction and Health
The Spiritual Dimension of Relaxation in the Mediterranean Lifestyle
Bibliography
UNIT IV: Mediterranean Lifestyle in Clinical Practice
CHAPTER 12: Use of the Mediterranean Lifestyle Paradigm in the Prevention and Treatment of the Metabolic Syndrome
Definition and Health Burden of the Metabolic Syndrome
Lifestyle Medicine in Chronic Disease Management
Bibliography
CHAPTER 13: Obesity Case Study
Assessment
Obesity Management
Bibliography
CHAPTER 14: Type 2 Diabetes Mellitus Case Study
Assessment
Type 2 Diabetes Mellitus Management
Bibliography
CHAPTER 15: Hypertension Case Study
Assessment
Hypertension Management
Bibliography
CHAPTER 16: Dyslipidemia Case Study
Assessment
Dyslipidemia Management
Bibliography
Appendix A: Answers to Self‐Assessment Questions
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Appendix B: Dietary Models and One‐Day Sample Meal Plans
B.1. The Therapeutic Lifestyle Changes (TLC) Dietary Model
B.2. The Dietary Approaches to Stop Hypertension (DASH) Dietary Model
B.3. The Vegetarian Dietary Model
B.4. Dietary Considerations and Requirements for Christians
B.5. Dietary Considerations and Requirements for Buddhists
B.6. Dietary Considerations and Requirements for Hindus
B.7. Dietary Considerations and Requirements for Jews
B.8. Dietary Considerations and Requirements for Muslims during Ramadan
B.9. The Nordic Dietary Model
B.10. The Healthy Asian Dietary Model
B.11. The Mediterranean Dietary Model
Bibliography
Appendix C: Food Components of the Mediterranean Diet
Cereals
Fruits and Vegetables
Olive Oil
Spices and Herbs
Dairy Products
Legumes
Fish
Red and Processed Meat
Potatoes
Sweets
Wine and Spirits
Appendix D: Assessment Tools for the Various Lifestyle Components
1. 24‐Hour Dietary Recall
2. Food Frequency Questionnaire
3. The Mediterranean Diet Score (MedDietScore)
4. The 14‐Item Mediterranean Diet Adherence Screener
5. The Short‐Form International Physical Activity Questionnaire (IPAQ)
6. The Athens Physical Activity Questionnaire (APAQ)
7. The Pittsburgh Sleep Quality Index (PSQI)
8. The Berlin Questionnaire
9. The STOP‐BANG Questionnaire
10. The Perceived Stress Scale (PSS)
11. The Zung Self‐Rating Anxiety Scale (SAS)
References
Glossary
Index
End User License Agreement
List of Tables
Chapter 2
TABLE 2.1
Technological clashes with our biology.
Chapter 6
TABLE 6.1
The basic principles of the TLC diet.
a
Chapter 7
TABLE 7.1
Contribution of the main food groups to the Cretan diet (%) compared w
...
TABLE 7.2
Comparison of the MedD pyramids, published 1993–2011.
Chapter 8
TABLE 8.1(a)
Adjusteda daily mean dietary intakes by report of social eating amo
...
TABLE 8.1(b)
Adjusteda daily mean dietary intakes by report of eating on the run
...
Chapter 9
TABLE 9.1
Physical activity domains.
TABLE 9.2
Classification of physical activity intensity.
TABLE 9.3
Overview of methods used to assess physical activity.
TABLE 9.4
Evolution of physical activity recommendations by the American College
...
TABLE 9.5
Recommendations for physical activity per age group.
TABLE 9.6
The Keys' dietary advice for prevention of coronary heart disease (195
...
Chapter 12
TABLE 12.1
Criteria for clinical diagnosis of the metabolic syndrome.
TABLE 12.2
Recommended waist circumference thresholds.
TABLE 12.3
Differences between conventional and lifestyle medicine approaches.
...
Chapter 13
TABLE 13.1
Classification of BMI values in adults.
TABLE 13.2
Morbidity risk according to BMI and WC values.
TABLE 13.3
Overview of body composition assessment methods.
TABLE 13.4
Findings on clinical/physical assessment and possible causes/explanati
...
TABLE 13.5
Laboratory assessments to be considered in obese patients.
TABLE 13.6
Overview of dietary assessment methods.
TABLE 13.7
Characteristics of dietary assessment methods.
TABLE 13.8
Overview of physical activity assessment methods.
TABLE 13.9
Level of intervention based on BMI and WC values.
TABLE 13.10
The Edmonton Obesity Staging System.
TABLE 13.11
Dietary approaches that can produce weight loss in obese adults.
TABLE 13.12
The Schofield equations for the estimation of BMR.
TABLE 13.13
Physical activity guidelines for adults 18–64 years.
a
TABLE 13.14
Overview of techniques used to facilitate behavior change.
Chapter 14
TABLE 14.1
Criteria for the diagnosis of diabetes mellitus.
TABLE 14.2
Goals of nutrition therapy for patients with T2DM.
TABLE 14.3
Widely used non‐nutritive sweeteners.
TABLE 14.4
The average glycemic index of common foods.
TABLE 14.5
Carbohydrate content of major food groups.
TABLE 14.6
Key topics for nutrition education in patients with T2DM.
TABLE 14.7
Recommended dietary changes for the management of T2DM.
Chapter 15
TABLE 15.1
Guidelines for the classification of blood pressure levels.
TABLE 15.2
Protocol for blood pressure evaluation in clinical practice.
TABLE 15.3
Suggested lifestyle interventions for patients with hypertension.
TABLE 15.4
Sodium content of major food groups.
TABLE 15.5
Recommended dietary changes for the management of hypertension.
TABLE 15.6
The “Five As” for a smoking cessation strategy for routine practice.
...
Chapter 16
TABLE 16.1
Physical and chemical characteristics of plasma lipoproteins.
TABLE 16.2
Assessment of lipidemic profile.
TABLE 16.3
Treatment goals for increased plasma LDLC levels.
TABLE 16.4
Treatment targets and goals for cardiovascular disease prevention.
TABLE 16.5
Impact of changes in macronutrient intake on blood lipid levels.
TABLE 16.6
Food choices to improve the overall lipoprotein profile.
3
TABLE C.1
Compositional features of fruits and vegetables.
TABLE C.2
Phytochemicals: functions and presence in fruits and vegetables.
TABLE C.3
Olive oil classification.
TABLE C.4
Use of common herbs and spices.
TABLE C.6
Beans and legumes with high protein content.
TABLE C.7
Seasonality of fish in the Mediterranean region.
List of Illustrations
Chapter 1
FIGURE 1.1 The Illness‐Wellness Continuum.
FIGURE 1.2 Six Dimensions of Wellness Model. ©1976 Bill Hettler, MD.
Chapter 2
FIGURE 2.1 Results of the Global Burden of Disease Collaborative Network,
Gl
...
FIGURE 2.2 Probability of dying from the four main noncommunicable diseases ...
FIGURE 2.3 Age‐standardized prevalence of underweight, obesity, and severe o...
Chapter 3
FIGURE 3.1 Trends in insufficient physical activity for three income groups ...
FIGURE 3.2 (a) Country prevalence of insufficient physical activity in women...
FIGURE 3.3 Total annual number of deaths by risk factor.
FIGURE 3.4 Map of the world showing estimated gains in life expectancy with ...
FIGURE 3.5 Distribution of alcohol‐attributable deaths, as a percentage of a...
FIGURE 3.6 Patterns of drinking score (15+ years), 2010.
FIGURE 3.7 Epigenetic mechanisms.
Chapter 4
FIGURE 4.1 Basic principles of a healthy lifestyle.
FIGURE 4.2 Association of alcohol with cancer.
Chapter 5
FIGURE 5.1 Perifollicular hemorrhages on both legs (a) and ecchymosis (b) ar...
Chapter 6
FIGURE 6.1 (a) Basic structure of the VegPlate, which is the same for adults...
FIGURE 6.2 The Baltic Sea diet pyramid.
FIGURE 6.3 The Asian diet pyramid.
FIGURE 6.4 The Japanese food guide spinning top.
FIGURE 6.5 Illustrations for the Chinese dietary guidelines launched in 2016...
Chapter 7
FIGURE 7.1 The Mediterranean Diet Pyramid.
FIGURE 7.2 The development of the Mediterranean diet over the centuries.
FIGURE 7.3 Data from Keys et al. depicting the correlation between percent c...
FIGURE 7.4 The Food Guide Pyramid – a guide to daily food choices (1992)....
FIGURE 7.5 The traditional healthy Mediterranean Diet Pyramid; first version...
FIGURE 7.6 The Traditional Healthy Mediterranean Diet with updated graphics,...
FIGURE 7.7 The MedD pyramid as depicted in the “Dietary Guidelines for Greek...
FIGURE 7.8 The Mediterranean pyramid today.
FIGURE 7.9 Herbal infusions can also contribute to adequate daily hydration....
Chapter 8
FIGURE 8.1 The components of the Mediterranean lifestyle.
FIGURE 8.2 Seasonality of fruits and vegetables in the Mediterranean region ...
FIGURE 8.3 The Med Diet 4.0 framework that applies the principles of sustain...
Chapter 9
FIGURE 9.1 Components of total energy expenditure in most individuals.
FIGURE 9.2 Health screening recommendations for participating in exercise pr...
FIGURE 9.3 The evolution of the Mediterranean diet pyramid. In 1993, OLDWAYS...
FIGURE 9.4 Mediterranean diet pyramid: a lifestyle for today. The place of p...
FIGURE 9.5 Conceptual figure of daily energy expenditure for a sedentary per...
FIGURE 9.6 Ecological model of four domains of active living. Broad categori...
FIGURE 9.7
Schematic representation of the modulation of NEAT in the context
...
Chapter 10
FIGURE 10.1 Progression of sleep states across a single night in a young adu...
FIGURE 10.2
The Siesta
, Camille Pissarro, 1899.
FIGURE 10.3 La Siesta, Vincent van Gogh, 1890.
FIGURE 10.4 Schematic representations of sleep recommendations based on diff...
FIGURE 10.5 Schematic representation of the ways in which sleep restriction ...
FIGURE 10.6 Sleeping Peasants, Pablo Picasso, 1919, Museum of Modern Art.
Chapter 13
FIGURE 13.1 Lifestyle events–body weight graph. Patients are asked to mark l...
FIGURE 13.2 Schematic diagram indicating the possible mechanisms linking obe...
Chapter 14
FIGURE 14.1 Pathophysiology of hyperglycemia in T2DM. Insulin secretion from...
FIGURE 14.2 Effects of high‐ and low‐GI foods on glucose homeostasis. GI, gl...
Chapter 15
FIGURE 15.1
Schematic illustration of the Mediterranean diet (above) and the
...
Chapter 16
FIGURE 16.1
Lipid metabolism.
CETP, cholesterol ester transfer protein; HDL,...
FIGURE 16.2
Schematic of the life history of an atheroma.
The normal human c...
FIGURE 16.3
Obesity and dyslipidemia.
The hallmark of dyslipidemia in obesit...
3
FIGURE C.1 Various kinds of cereals.
FIGURE C.2 (a) Fruits that thrive in the Mediterranean Basin. (b) Vegeta...
FIGURE C.3 The Mediterranean diet will cease to exist if the olive trees die...
FIGURE C.4 Olive oil and table olives.
FIGURE C.5 Typical herbs of the Mediterranean land.
FIGURE C.6 A plethora of spices are used in the Mediterranean region in vari...
FIGURE C.7 The traditional Mediterranean diet includes primarily fermented d...
FIGURE C.8 Legumes, a typical component of the Mediterranean diet, when comb...
FIGURE C.9 Typical Mediterranean fish species (sardines).
FIGURE C.10 White meat is consumed on a weekly basis in the traditional Medi...
FIGURE C.11 Red meat is rarely consumed within the frame of the traditional ...
FIGURE C.12 In Greece during Easter people cook
tsoureki,
a kind of sweet br...
FIGURE C.13 Wine intake in the presence of good company has always strengthe...
Guide
Cover Page
Textbook of Lifestyle Medicine
Textbook of Lifestyle Medicine
Dedication Page
About the Authors
Preface
Abbreviation List
Table of Contents
Begin Reading
Appendix A Answers to Self‐Assessment Questions
Appendix B Dietary Models and One‐Day Sample Meal Plans
Appendix C Food Components of the Mediterranean Diet
Appendix D Assessment Tools for the Various Lifestyle Components
Glossary
Index
WILEY END USER LICENSE AGREEMENT
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Textbook of Lifestyle Medicine
LABROS S. SIDOSSIS, PHD
Rutgers, The State University of New Jersey New Brunswick, NJ, USA
STEFANOS N. KALES, MD, MPH
Cambridge Health Alliance/Harvard Medical School Cambridge, MA, USA
This edition first published 2022© 2022 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Labros S. Sidossis and Stefanos N. Kales to be identified as the authors of this work has been asserted in accordance with law.
Registered Office(s)John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Office9600 Garsington Road, Oxford, OX4 2DQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.
Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data Applied for
[PB: 9781119704423]
Cover Design: WileyCover Image: Cover Illustration © Eleni Chrysikou
Dedication
To our loving and supportive parents and families. They taught us, continue to inspire us, and make us work hard, because they know that physical exertion is good for our health! This book would not have been possible without you.
About the Authors
Dr Labros S. Sidossis, PhD, FTOS, FAHA, FNAK is a Distinguished Professor and Chairperson of the Department of Kinesiology and Health and Professor of Medicine at the Robert Wood Johnson Medical School at Rutgers University. He has a BS in Kinesiology, an MS in Exercise Physiology, an MA in Exercise Biochemistry and Nutrition, and a PhD in Nutrition – Metabolic Biochemistry from the University of Texas Medical Branch at Galveston.
His research over the past 30 years has focused on the role of lifestyle factors in the pathophysiology, prevention, and treatment of various noncommunicable diseases, including obesity, insulin resistance, and dyslipidemias. His studies have been funded by the US National Institutes of Health, the American Diabetes Association, the Shriners Hospitals for Children, the European Union, and the industry. His 200+ publications in peer‐reviewed journals have been cited >15,000 times.
Dr. Sidossis has been an inspiring teacher for undergraduate and graduate students in the fields of nutrition, physical activity, and health. He has developed and taught numerous undergraduate and graduate courses in these disciplines in the European and US universities, and has published four textbooks.
Dr. Stefanos N. Kales, MD, MPH, FACP, FACOEM is Professor of Medicine, Harvard Medical School; Professor ' Director of the Occupational Medicine Residency, Harvard Chan School of Public Health; and Chief of Occupational Medicine /Employee Health, Cambridge Health Alliance, a Harvard-affiliated system. He has participated in medical and public health activities on five continents resulting in over 200 publications and wide recognition internationally. He is a faculty member in Harvard‛s Cardiovascular Epidemiology Program and its Division of Sleep Medicine.
Dr. Kales has received numerous honors, including the Kehoe and Harriet Hardy Awards for outstanding scientific contributions. He has organized several groundbreaking Mediterranean Diet/Lifestyle Conferences (Harvard Chan 2014, Halkidiki-Greece 2017 and Harvard‛s Radcliffe Institute 2019). Dr. Kales leads by example, following a Mediterranean diet, practicing regular physical fitness and good sleep hygiene. Based on the scientific evidence, he is convinced that lifestyle measures are the most accessible and cost-effective of chronic disease prevention and control.
Preface
We are thrilled to share this book with you. It is the product of more than 50 years of combined research, practice, and teaching on modifiable lifestyle factors affecting human health. We have been struggling in the lab, classroom, clinic, and workplace for years to understand the epidemiology and pathophysiology of some of today's most common diseases (e.g., obesity, type 2 diabetes mellitus, hypertension, and dyslipidemia) and to find nonpharmacological ways to prevent and mitigate these disorders. Our work has contributed a small fraction to the tremendous progress that has been accomplished during the past few decades by many excellent labs, research institutions, and centers around the world, led by brilliant colleagues, investigators, teachers, and clinicians.
We have tried to evaluate, understand, organize, and translate all this knowledge into clinical practice and share it with you. You will be the judge if we have succeeded in this endeavor. Our main goal was not only to provide accurate and trusted knowledge to undergratuate and graduate students but also to make available the tools for current and future clinicians to translate this knowledge into best practices.
Lifestyle factors and the way individuals conduct their lives have recently received great attention, since these factors are modifiable and, therefore, may be subject to considerable intervention and improvement. Many healthy lifestyle choices – such as sensible diets, adequate physical activity, avoiding tobacco use, moderate alcohol intake, good social life, and stress‐reduction – have been associated with lower risks of obesity, insulin resistance, hypertension, dyslipidemia, and other chronic diseases, which are considered the major public health concerns of our time. Therefore, scientific research on the lifestyle factors that may have negative (unhealthy lifestyle) or positive (healthy lifestyle) effects on health has intensified during the past 20 years.
The findings are very encouraging; even small changes toward healthier lifestyle choices can translate into substantial health benefits. The clinical implications are so significant that the first professional organizations to promote lifestyle changes as a primary means to treat diseases were formed. In 2004, the American College of Lifestyle Medicine (ACLM) was formed to provide education and certification to health professionals who want to use lifestyle changes as the foundation of transformed and sustainable health‐care systems. Soon after, many similar organizations were formed around the world (e.g., Lifestyle Medicine Global Alliance, European Lifestyle Medicine Council, European Lifestyle Medicine Organization, British Society of Lifestyle Medicine, Australasian Society of Lifestyle Medicine). According to the ACLM, “Lifestyle Medicine is the use of a whole food, plant‐predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.”
We do not consider ourselves the ultimate authorities in all the scientific areas covered in this book. But this is exactly the main message of our book: metabolic health is a multifaceted entity requiring a multidisciplinary approach. No one can be an expert in all components of lifestyle: diet, physical activity, stress, sleep, substance use and abuse. However, it is crucial for all health‐care professionals who treat patients suffering from chronic diseases to understand the importance of lifestyle choices and help patients to best utilize those choices to their own benefit.
The book is divided into four units to present these complex subjects in a clear and concise manner.
Unit I: Lifestyle Choices and Human Health begins by providing the basic knowledge necessary to introduce students and scientists with diverse backgrounds to this relatively new area of research and practice and the related terminology: healthy lifestyle, wellness, and lifestyle medicine. Next it presents in detail the characteristics and principles of healthy and unhealthy lifestyle choices.
Unit II: Healthy Diets presents the history of how our nutrition habits, the most studied of all lifestyle factors, evolved to what they are today, and discusses the methods scientists have used to evaluate the connections among food, health, and disease. Subsequently, we present several of the world's most important dietary models/patterns, followed by billions of people. Finally, we finish this unit with one of the best‐known and evidence‐based eating patterns, the Mediterranean dietary pattern. One‐day sample meal plans for all dietary models/patterns are presented in Appendix B.
Unit III: From Mediterranean Diet to Mediterranean Lifestyle describes the major milestones in the development of our current understanding of building and maintaining health and well‐being. We can no longer consider diet as the sole determinant of health. We now recognize that other lifestyle factors (physical activity, sleep, stress management, social life, substance use and abuse) are equally important; furthermore, it is the synergistic effect of all these factors that leads to a healthy lifestyle, a life not only with less disease but a state of physical, mental, and social well‐being.
Unit IV: Mediterranean Lifestyle in Clinical Practice presents four case studies, each devoted to one of the prominent features of the metabolic syndrome: obesity, type 2 diabetes mellitus, hypertension, and dyslipidemia. For each case, we present a detailed, step‐by‐step description of the methods a clinician should use to evaluate a patient's lifestyle. Next, we describe general treatment protocols utilizing lifestyle modifications pertinent to the specific disorders. We hope that this section will become a useful tool in the hands of clinicians when managing patients utilizing lifestyle medicine as the first, and possibly most important, line of defense against noncommunicable diseases, before resorting to prescription drugs with possible side effects.
The book has six distinctive features:
It is inclusive of all the major lifestyle factors affecting human health.
It has a textbook format and can be used for undergraduate and graduate teaching.
It uses the unique and evidence‐based perspective of the traditional Mediterranean lifestyle as the gold standard of a healthy lifestyle. A plethora of scientific evidence supports the notion that the traditional Mediterranean diet/lifestyle is one of the healthiest diet/lifestyle patterns. The 2015 Dietary Guidelines for Americans identify the Healthy Mediterranean‐Style Eating Pattern/Lifestyle as probably the healthiest and easiest to follow.
The “Take‐Home Messages” at the end of each chapter denote the most important points of the chapter.
The “Key Points” throughout the book help the reader focus on important points.
Finally, to assist the reader/student in comprehending the presented material, at the end of each chapter we present a list of “Self‐Assessment Questions” with answers provided in
Appendix A
.
We hope that this book will become a valuable resource to students in medical and health‐related disciplines, and to health professionals such as nutritionists, exercise physiologists, psychologists, addiction specialists, sleep therapists, athletic trainers, physicians, nurses, and other health professionals who are using or considering using lifestyle changes to prevent and treat noncommunicable diseases. The Clinical Cases section provides specific practical tools to assist with everyday practice in the clinic; the materials presented apply to most noncommunicable diseases of today (e.g., cardiovascular disease, autoimmune diseases, stroke, most cancers, chronic kidney disease, osteoarthritis, osteoporosis), not only the specific examples we are presenting.
We are indebted to Christina Katsagoni, PhD; Michael Georgoulis, PhD; Elena Bellou, PhD; Anastasia Diolintzi, PhD; Anastasia Papadimitriou, PhD; Glykeria Psarra, PhD; Amalia Sidossis, MD; and Ioanna Katsaroli, MS. These talented young scientists contributed tremendously to this book by offering ideas regarding book format and content, conducting thorough literature reviews, drafting and editing sections or chapters, and offering constructive criticism throughout the writing of this book. Special thank you to Christina and Michael for their invaluable help during the final stages of book editing. We would not be able to do it without them. Ms. Dafni Kyriakou was quick and effective as always in book formatting. We would also like to thank the Wiley team for their dedication and professionalism: James Watson, Anne Hunt, Tom Marriott, Cheryl Ferguson, P. Sathishwaran, and their colleagues. Finally, we would like to thank Sarah Brown for proofreading our book.
Last but not least, we want to thank our families for their continuous love and support.
LABROS S. SIDOSSIS, PHDPrinceton, New Jersey, USA
STEFANOS N. KALES, MD, MPHCambridge, Massachusetts, USA
Abbreviation List
(F)PG
(fasting) plasma glucose
(He)FH
(heterogenous) familial hypercholesterolemia
(hs)CRP
(high‐sensitivity) C‐reactive protein
(N)REM
(non‐)rapid‐eye‐movement
(S/D)BP
(systolic/diastolic) blood pressure
(V)LCD
(very) low‐calorie diet
(V)LDL(C)
(very) low‐density lipoprotein (cholesterol)
AACE
American Association of Clinical Endocrinologists
ACC
American College of Cardiology
ACE
American College of Endocrinology
ACLM
American College of Lifestyle Medicine
ACS
acute coronary syndrome
ACSM
American College of Sports Medicine
AD
Alzheimer’s disease
ADI
acceptable daily intake
ADP
air displacement plethysmography
AHA
American Heart Association
AHI
apnea‐hypopnea index
ALT
alanine transaminase
APA
American Psychological Association
APAQ
Athens Physical Activity Questionnaire
Apo
apolipoprotein
ApoB
apolipoprotein B
ARIC
Atherosclerosis Risk Communities
ASCVD
atherosclerotic cardiovascular disease
ATP
Adult Treatment Panel
BIA
bioelectrical impedance analysis
BIS
bioelectrical spectroscopy
BMI
body mass index
BMR
basal metabolic rate
BP
blood pressure
BW
body weight
CBT
cognitive–behavioral therapy
CDC
Centers for Disease Control and Prevention
CE
cholesterol esters
CETP
cholesterol ester transfer protein
CFG
Chinese Food Guide
CG
control group
CHD
coronary heart disease
CHNS
China Health and Nutrition Survey
CKD
chronic kidney disease
CLOCK
circadian locomotor output cycles kaput
CM
chylomicron
CNS
central nervous system
COPD
chronic obstructive pulmonary disease
CRD
chronic respiratory disease
CT
computed tomography
CVD
cardiovascular disease
DALY
Disability-Adjusted Life Years
DASH
Dietary Approaches to Stop Hypertension
DASH-CF
DASH with chicken and fish
DASH-P
DASH with lean pork
DEXA
dual‐energy X‐ray absorptiometry
DHA
docosahexaenoic acid
EAPC
European Association of Preventive Cardiology
EAS
European Atherosclerosis Society
EAT
Eating Among Teens
EEG
electroencephalograph
eGFR
estimated glomerular filtration rate
EPA
energy required for physical activity
EPA
energy required for physical activity
EPIC-NL
European Prospective Investigation into Cancer and Nutrition
EPIDIAR
Epidemiology of Diabetes and Ramadan
ESC
European Society of Cardiology
EVOO
extra-virgin olive oil
FDA
Food and Drug Administration
FFA
free fatty acids
FFQ
food frequency questionnaire
FTO
fat-mass obesity
GDM
gestational diabetes mellitus
GDS
Geriatric Depression Scale
GI
glycemic index
GL
glycemic load
GWAS
genome‐wide association study
HbA1c
glycated/glycosylated hemoglobin
HDL(C)
high‐density lipoprotein (cholesterol)
HEI
Healthy Eating Index
HF
heart failure
HF-DASH
high-fat DASH
HL
hepatic lipase
HOMA‐IR
Homeostatic Model Assessment of Insulin Resistance
HPA
hypothalamic‐pituitary‐adrenal
HPV
human papilloma virus
HR
heart rate
HRQoL
health‐related quality of life
HRR
heart rate reserve
IDF
International Diabetes Federation
IDL(C)
intermediate‐density lipoprotein (cholesterol)
IHD
ischemic heart disease
IHME
Institute for Health Metrics and Evaluation
IL-1β
interleukin-1β
IL-6
interleukin-6
IL-18
interleukin-18
IMT
intima‐media thickness
IOOC
International Olive Oil Corporation
IPAQ
International Physical Activity Questionnaire
IR
insulin resistance
ISAAC
International Study on Allergies and Asthma in Childhood
LCD
low-calorie diet
LDL
low-density lipoprotein
Lp(a)
lipoprotein a
LPL
lipoprotein lipase
MCI
mild cognitive impairment
MDG
Mediterranean diet group
MedD
Mediterranean diet
MedL
Mediterranean lifestyle
MEST
mesoderm-specific transcript
MET
metabolic equivalent of task
MetS
metabolic syndrome
MI
motivational interviewing
MI
myocardial infarction
MLG
Mediterranean lifestyle group
MRI
magnetic resonance imaging
MRS
magnetic resonance spectroscopy
MUFA
monounsaturated fatty acid
NAFLD
nonalcoholic fatty liver disease
NASH
nonalcoholic steatohepatitis
NCD
noncommunicable disease
NCEP
National Cholesterol Education Program
NEAT
nonexercise activity thermogenesis
NEFAs
non-esterified fatty acids
NHLBI
National Heart, Lung and Blood Institute
NHS
Nurses’ Health Study
NICE
National Institute for Health and Care Excellence
NIH
National Institutes of Health
NSF
National Sleep Foundation
NWI
National Wellness Institute
OGTT
oral glucose tolerance test
OSA
obstructive sleep apnea
PA
physical activity
PAE
physical activity expenditure
PCA
principal component analysis
PCOS
polycystic ovary syndrome
PCP
primary care physician
PD
Parkinson’s disease
PF
physical fitness
PKU
phenylketonuria
PL
phospholipid
PREDIMED
Prevencion con Dieta Mediterranea
PSQI
Pittsburgh Sleep Quality Index
PSS
Perceived Stress Scale
PUFA
polyunsaturated fatty acid
QoL
quality of life
RA
rheumatoid arthritis
RCT
randomized controlled trial
REE
resting energy expenditure
REM
rapid eye movement
ROS
reactive oxygen species
RPE
rating of perceived exertion
SAS
Zung Self-Rating Anxiety Scale
SCN
suprachiasmatic nucleus
SCORE
Systematic Coronary Risk Evaluation
SCS
Seven Countries Study
SENECA
Survey in Europe on Nutrition and the Elderly Concerted Action
SFA
saturated fatty acid
SNP
single‐nucleotide polymorphism
STP
systolic blood pressure
SUN
Seguimiento Universidad de Navarra
T1/2DM
type 1/2 diabetes mellitus
TAG
triacylglycerol
TC
total cholesterol
TEE
total energy expenditure
TEF
thermic effect of food
TFA
trans fatty acid
TG
triglycerides/triacylglycerols
TIA
transient ischemic attack
TLC
Therapeutic Lifestyle Changes
TNF-α
tumor necrosis factor-α
TRL
triglyceride‐rich lipoprotein
ULSAM
Uppsala Longitudinal Study of Adult Men
UNESCO
United Nations Educational, Scientific and Cultural Organization
USDA
United States Department of Agriculture
VO
2
max
maximal aerobic capacity
VOO
virgin olive oil
WC
waist circumference
WELL
Wellbeing, Eating and Exercise for a Long Life
WHO
World Health Organization
UNIT ILifestyle Choices and Human Health
CHAPTER 1Basic Concepts: Health, Wellness, and Lifestyle
Day by day, what you choose, what you think and what you do is who you become.
Heraclitus (Ancient Greek, pre‐Socratic, Ionian philosopher)
Health is considered the most valuable asset of our lives and central to human happiness. According to Hippocrates (Ancient Greek physician, also known as the Father of Medicine), “A wise man should consider that health is the greatest of human blessings, and learn how, by his own thought, to derive benefit from his illnesses.” Defining health is not as straightforward as it may seem; various definitions have been given through the years, gradually incorporating many aspects of human life.
Early definitions conceptualized health primarily as the absence of disease. The World Health Organization (WHODay by day, what you choose, what you think and what you do is who you become.Heraclitus (Ancient Greek, pre‐Socratic, Ionian philosopher)Health is considered the most valuable asset of our lives and central to human happiness. According to Hippocrates (Ancient Greek physician, also known as the Father of Medicine), “A wise man should consider that health is the greatest of human blessings, and learn how, by his own thought, to derive benefit from his illnesses.” Defining health is not as straightforward as it may seem; various definitions have been given through the years, gradually incorporating many aspects of human life.Early definitions conceptualized health primarily as the absence of disease. The World Health Organization (WHO) was the first to introduce a more holistic definition of health in 1948: “Health is a state of complete physical, mental and social well‐being and not merely the absence of disease or infirmity.” This more inclusive concept of health, which encompasses the multifaceted nature of human beings, has recently gained ground. The suggestion that health has a positive component, instead of just the absence of a negative one, i.e., illness, gradually led to the use of other terms, such as wellness and well‐being.
Key Point
“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” WHO
Wellness can be described as optimal health in all three dimensions – body, mind, and spirit – within the limits of one's hereditary and personal traits. The term wellness was added in the WHO Health Promotion Glossary in 2006 to describe “the optimal state of health of individuals and groups, with two focal concerns: the realization of the individual's fullest potential physically, socially, spiritually, and economically, and the fulfilment of one's role expectations in the family, community, place of worship, workplace, and other settings.” Figure 1.1 illustrates the Illness‐Wellness Continuum proposed by John W. Travis According to this view, wellness is not just the absence of disease, but it incorporates the individual's mental and emotional health. The right side of the Continuum reflects degrees of wellness. Individuals can move further to the right, toward health and wellness, through awareness, education, and growth. The left side of the Continuum reflects degrees of illness or worsening states of health, reflected by signs, symptoms, and disability. This approach underlined that traditional Western medicine typically treats injuries, disabilities, and symptoms, to bring the individual to a “neutral point” but not to achieve a high level of wellness.
FIGURE 1.1 The Illness‐Wellness Continuum.
Source: Travis (1977). Reprinted with permission from the Wellness Association.
The National Wellness Institute (NWI) introduced the “Six Dimensions of Wellness” model that includes physical, occupational, social, intellectual, spiritual, and emotional parameters (Figure 1.2). According to this model, the feature of consciousness is critical in achieving and maintaining wellness. It gives the impetus to opt for choices, which will enhance a person’s maximal capabilities. In addition, wellness is characterized by positiveness – a complex condition that incorporates balance and harmony in lifestyle, environmental, mental, and spiritual features. According to the NWI, “Wellness is an active process through which people become aware of, and make choices toward a more successful existence.”
Key Point
“Wellness is an active process through which people become aware of, and make choices toward, a more successful existence.” NWI
FIGURE 1.2 Six Dimensions of Wellness Model. ©1976 Bill Hettler, MD.
Source: Reprinted with permission from the National Wellness Institute, Inc. (2020).
The holistic character of wellness integrates the effects of frequent physical activity, sound dietary habits, self‐reliance, and determination but also self‐confidence, assertiveness, mental creativity, and inventiveness, along with the eagerness to share one's virtues with others. For optimal health, a person is expected to be physically able to fulfill everyday activities without disproportionate tiredness or stress. To this end, physical wellness can be achieved by the adaption of health‐promoting practices, such as regular physical activity, healthy dietary and sleeping habits, and the rejection of the detrimental ones (e.g., undue stress, excessive alcohol intake, and use of tobacco or other substances).
Occupational (or vocational) wellness pertains to the satisfaction gained in the workplace, in balance with personal life. Employment is associated with personal satisfaction and life enrichment comparable with someone's goals, values, and lifestyle, offering unique skills and talents that are meaningful and rewarding. Furthermore, being socially involved (i.e., social wellness) means being harmoniously related to other people and efficiently sustaining positive intimate bonds with family, friends, and colleagues. Emotional wellness refers to the trait of self‐consciousness and the state of being in harmony with oneself, as well as coping with life’s adversities and expressing one's feelings in a constructive way. Spiritual wellness delineates the state of living peacefully by achieving concordance between ethical principles and course of action in combination with creativity. In a similar way, intellectual wellness refers to the adeptness of being receptive to different views and perspectives, and constructively encompassing them in future decision‐making, not only on a personal level but also while interacting with the social environment in an attempt to improve it. In addition, the environmental dimension refers to the acknowledgment of the effect that people exert on their environmental surroundings (i.e., air, water, and land) and the adoption of such practices that sustain and preserve the environment. Finally, the term financial wellness refers to the sense of satisfaction when people manage to live within their means. This involves making the appropriate financial decisions, setting realistic goals, and preparing to meet their short‐ and long‐term needs.
The assessment of the various aspects of well‐being is subjective. It depends on the perceived views a person holds, rather than his or her actual abilities. For example, a person might have a very important job, but the perception and satisfaction might be negative, whereas another person with a less important job might be more satisfied with his or her work. Therefore, healthy thinking and positive outlook are essential features to ensure overall wellness.
Key Point
Healthy thinking and positive outlook are essential features to ensure overall wellness.
Given the important role of health throughout life, scientific research has, from very early on, been focused on factors that could affect health. The genetic background has been acknowledged to be crucial to an individual's health. For example, heritability estimates for type 2 diabetes mellitus (T2DM) range from 20% to 80%. High estimates for the heritability of obesity have also been proposed (typically >70%). However, the exposure to an obesogenic environment is necessary for the development of T2DM and obesity, suggesting that the genetic background is important, but several other environmental/lifestyle factors may also exert a cumulative effect on human health.
Key Point
The genetic background is important, but several other environmental/lifestyle factors may also exert a cumulative effect on human health.
Lifestyle choices and the way the individuals conduct their lives have recently received great attention, since these factors are modifiable and, therefore, may be subject to intervention and improvement. Lifestyle factors that may affect health include habits, attitudes, tastes, moral standards, economic level, activities, interests, opinions, and values. It is a constellation of motivations, needs, and wants, influenced by factors such as culture, family, reference groups, and social class. Many unhealthy lifestyle choices, such as poor diet, physical inactivity, tobacco use, excessive alcohol intake, and excessive stress have been associated with the development of many chronic diseases. Therefore, scientific research on the lifestyle factors that may have negative (unhealthy lifestyle) or positive (healthy lifestyle) effects on health has intensified over the last decades.
Key Point
Even small changes toward healthy lifestyle choices can translate to significant benefits in the prevention and treatment of chronic diseases.
The findings are very encouraging; even small changes toward healthy lifestyle choices can translate to significant benefits in the prevention and treatment of chronic diseases. The clinical significance is so obvious that a few years ago the first professional organizations to promote lifestyle changes as a means to prevent and treat diseases were formed. In 2004 the American College of Lifestyle Medicine (ACLM) was formed to provide education and certification to health professionals who wanted to use lifestyle changes as the foundation of a transformed and sustainable health‐care system. According to the ACLM, “Lifestyle Medicine is the use of a whole‐food, plant‐predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.”
Key Point
“Lifestyle Medicine is the use of a wholefood, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.” ACLM
Soon after the ACLM was formed, many similar organizations were formed (e.g., Lifestyle Medicine Global Alliance, European Lifestyle Medicine Council, European Lifestyle Medicine Organization, British Society of Lifestyle Medicine, Australasian Society of Lifestyle Medicine), demonstrating the global realization of the benefits of lifestyle medicine.
Take‐Home Messages
Wellness is the holistic integration of an individual's physical, mental, and spiritual health.
The “Six Dimensions of Wellness” are physical, occupational, social, intellectual, spiritual, and emotional wellness.
Healthy thinking and positive outlook are essential features to ensure overall wellness.
Several parameters such as the genetic background and environmental and lifestyle factors affect human health.
Lifestyle choices, as modifiable factors, may have negative (unhealthy lifestyle) and positive (healthy lifestyle) impact on health.
Self‐Assessment Questions
How has the definition of health evolved through the years?
Give the definition of wellness according to the NWI.
What are the Six Dimensions of Wellness according to the NWI?
Physical wellness can be achieved through:
regular physical activity
healthy dietary habits
adequate sleep
the rejection of detrimental habits (e.g., undue stress, excessive alcohol intake, and use of tobacco or other substances)
all of the above
Emotional wellness refers to:
the satisfaction gained in the workplace, in balance with personal life
the trait of self‐consciousness and the state of being in harmony with oneself as well as coping with life’s adversities and expressing one's feelings in a constructive way
being harmoniously related to other people and efficiently sustaining positive intimate bonds
the adeptness of being receptive to different views and perspectives, and constructively encompassing them in future decision‐making
the sense of satisfaction when someone manages to live within his or her means
Which components of the unhealthy lifestyle have been associated with the development of chronic diseases?
Give the definition of lifestyle medicine.
Bibliography
Birrell, F.N., Pinder, R.J., and Lawson, R.J. (2021). Lifestyle medicine is no Trojan horse: it is an inclusive, evidence‐based, and patient‐focused movement.
Br. J. Gen. Pract.
71 (708): 300. doi: 10.3399/bjgp21X716201.
Frates, E.P. and Bonnet, J. (2016). Collaboration and negotiation: the key to therapeutic lifestyle change.
Am. J. Lifestyle Med.
10 (5): 302–312. doi: 10.1177/1559827616638013.
Frates, E.P., Morris, E.C., Sannidhi, D. et al. (2017). The Art and science of group visits in lifestyle medicine.
Am. J. Lifestyle Med.
11 (5): 408–413. doi: 10.1177/1559827617698091.
Kent, K., Johnson, J.D., Simeon, K. et al. (2016). Case series in lifestyle medicine: a team approach to behavior changes.
Am. J. Lifestyle Med.
10 (6): 388–397. doi: 10.1177/1559827616638288.
Lalley, N.A., Manger, S.H., Jacka, F. et al. (2021). The Mind‐Body Well‐being Initiative: a better lifestyle for people with severe mental illness.
Australas Psychiatry
, 1039856220978864. doi: 10.1177/1039856220978864.
Lawson, R. (2020). British Society of Lifestyle Medicine: founding principles and current achievements.
Am. J. Lifestyle Med.
14 (3): 286–288. doi: 10.1177/1559827619867627.
Masic, I. (2015). Determinants of health and health concepts according to WHO targets.
Int. J. Biomed. Health
3: 16–21.
National Wellness Institute (NWI). (2020). The Six Dimensions of Wellness.
www.nationalwellness.org.
Phillips, E.M., Frates, E.P., and Park, D.J. (2020). Lifestyle medicine.
Phys. Med. Rehabil. Clin. N. Am.
31 (4): 515–526. doi: 10.1016/j.pmr.2020.07.006.
Saper, R.B. (2017). Integrative medicine and health.
Med. Clin. N. Am.
101 (5): xvii‐xviii. doi: 10.1016/j.mcna.2017.07.002.
Smith, B.J., Tang, K.C., and Nutbeam, D. (2006). WHO health promotion glossary: new terms.
Health Promot. Int.
21 (4): 340–345.
Stoewen, D.L. (2017). Dimensions of wellness: change your habits, change your life.
Can. Vet. J.
58 (8): 861–862.
Travis, J.W. (1977).
Wellness Workbook: A Guide to Attaining High Level Wellness
. Wellness Resource Center.
Travis, J.W. and Ryan, R.S. (2004).
The Wellness Workbook: How to Achieve Enduring Health and Vitality
, 3e. Random House Digital.
CHAPTER 2The Lifestyle Disease Epidemic: Global Burden and Risk Factors
Lifestyle diseases are diseases linked to the way people live their lives and represent a leading threat to human health and human development. They are chronic conditions that do not result from an acute infectious process. They are noncommunicable diseases (NCDs), they have a prolonged course, they are not cured spontaneously, and a complete cure is rarely achieved. Finally, lifestyle diseases may result from a combination of genetic, physiological, environmental, and behavioral factors. NCDs include cardiovascular diseases (CVDs; e.g., coronary heart disease [CHD] and stroke), cancer, chronic respiratory disease (CRD), type 2 diabetes mellitus, chronic neurologic disorders (e.g., Alzheimer's, dementia), arthritis/musculoskeletal diseases, and unintentional injuries (e.g., from traffic accidents). According to the World Health Organization (WHO), NCDs cause more deaths than all other causes combined, and NCD deaths are projected to increase from 38 million in 2012 to 52 million by 2030. Figure 2.1 shows the proportion of deaths by cause among people who were 70 years and older.
Key Point
NCDs cause more deaths than all other causes combined.
Globally, approximately 45% of all NCD deaths occur before the age of 70 years. Figure 2.2 shows the country‐dependent probability of dying from the four main NCDs between the ages of 30 and 70 years.
In general, NCDs have a multifactorial etiology. Risk factors include certain aspects of lifestyle as well as environmental and genetic determinants. It is well known that genetic predisposition alone cannot explain all the disease risk; lifestyle and environmental factors are also key contributors.
Key Point
NCDs have a multifactorial etiology. Risk factors include certain aspects of lifestyle as well as environmental and genetic determinants.
Genetic Background and NCD Development
Genetic predisposition has been acknowledged to have a significant contribution to the incidence of NCDs. A number of mutations in the coding regions of the human genome have been considered as causative factors for various NCDs. Nonsynonymous nucleotide substitutions result in missense, nonsense, or frameshift changes in protein coding sequence; this may lead to loss‐of‐function or gain‐of‐function in certain proteins that have linked with specific disease phenotypes. However, the vast majority of single‐nucleotide polymorphisms (SNPs) are distributed throughout the human genome, in the noncoding regions. Therefore, it is difficult to establish a causal relationship between the allelic variants originating from SNPs and the disease phenotype.
The relationship between heritable genetic traits and metabolic morbidity has been accrued through genome‐wide association studies (GWASs), which examine similarities in the entire DNA sequence of different people, as regards specific SNPs, and the presence of certain diseases across this population. Data from GWASs have shown that SNPs are preferentially concentrated in functional genomic regions, namely enhancer elements, DNase hypersensitivity regions, and epigenetically important chromatin markers, playing a crucial role in the development of a variety of diseases, including cancer, stroke, and cerebrovascular diseases. Moreover, the epigenetic modifications in the form of DNA methylation lay among the most critical processes that could change gene expression, while at the same time leaving intact the nucleotide sequence (please refer to Chapter 3 for more information about the epigenetic mechanism).
FIGURE 2.1 Results of the Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2017. Institute for Health Metrics and Evaluation (IHME) (2018).
FIGURE 2.2 Probability of dying from the four main noncommunicable diseases between the ages of 30 and 70 years, comparable estimates, 2012.
Source: Reprinted with permission from WHO Library Cataloguing‐in‐Publication Data Global Status Report on Noncommunicable Diseases, 2014 ed.
Diet, physical activity, sleep patterns, and stress have been shown to significantly affect the development of many NCDs. These factors can influence pathogenetic pathways and even gene expression, and therefore may positively or negatively affect the development of a disease. In the following paragraphs, we are presenting the epidemiology of the most important NCDs and the effect of the modern lifestyle. The protective role of several other lifestyle aspects in NCDs will be presented in Unit III.
Obesity: Epidemiology and Impact of Modern Lifestyle
The prevalence of obesity has nearly doubled since 1980. More than 39 million children under the age of 5 were overweight or obese in 2020; 13% of adults in the world were obese in 2020, whereas 39% were overweight. The prevalence of obesity varies significantly between countries (Figure 2.3.).
This “globesity” phenomenon may have contributed to the rise in the global incidence of major NCDs. Obesity often leads to adverse effects on blood pressure (BP), cholesterol, triacylglycerols (TAGs), and insulin resistance (IR). The risk of CHD, ischemic stroke, and type 2 diabetes mellitus (T2DM) increases steadily with increasing body mass index (BMI). Overweight and obesity have also been associated with several types of cancer – namely, breast, colon, prostate, endometrium, kidney, and gall bladder cancer. Furthermore, overall mortality rates seem to be higher among severely obese individuals compared to the general population.
FIGURE 2.3 Age‐standardized prevalence of underweight, obesity, and severe obesity by sex and country in 2014. Underweight (BMI < 18.5 kg/m2); obesity (BMI ≥ 30 kg/m2); and severe obesity (BMI ≥ 35 kg/m2).
Source: NCD Risk Factor Collaboration (2016).
Key Point
The “globesity” phenomenon may have contributed to the rise in the global incidence of major NCDs.
The genetic background plays a crucial role in the development of obesity and obesity‐associated comorbidities. However, genes cannot be changed. Among several modifiable risk factors, physical inactivity, unhealthy diet, sleep deprivation, and chronic stress overload are the main contributors of overweight and obesity. These lifestyle behaviors not only acutely affect weight status but may also cause epigenetic modifications; i.e., these habits hold the potential to affect the expression of certain genes in the long term, which, in turn, can influence the predisposition to some chronic diseases.
Obesity is the consequence of a long‐term energy imbalance, whereby energy intake is higher than energy expenditure. A dramatic change in the way people consume food, ingest drinks, and move has been recorded during the past decades. A significant increase in the consumption of energy‐dense foods and simple sugars has been recorded worldwide. At the same time physical activity has decreased, due to the sedentary character of the working environment, changes in transportation, and urbanization. Moreover, short sleep duration (i.e., less than 7 hours/day) has been associated with an increase in BMI and the risk for developing obesity. Hormonal changes seen with sleep deprivation could potentially increase food intake and contribute to weight gain. The increase of the glucocorticoid stress hormone cortisol may also play a role in the development of obesity by increasing the appetite with a preference for energy‐dense foods (“comfort food”).
Key Point
Obesity is the consequence of a long-term energy imbalance, whereby energy intake is higher than energy expenditure.
Overall, these unhealthy lifestyle behaviors and habits seem to be the result of environmental and social changes associated with the lack of supportive policies in sectors such as health, agriculture, education, transportation, urban planning, environment, distribution, and food trade. Although their involvement in the pathogenesis of obesity has not been fully elucidated, it is now clear that social and environmental factors may influence food intake and energy expenditure more than the internal regulatory mechanisms that regulate people’s weight. Moreover, the human body has been programmed to preserve energy, and this has deleterious effects when people are found in an obesogenic environment (Table 2.1). The proclivity of an individual to these environmental influences is affected by genetic and other biological factors.
TABLE 2.1Technological clashes with our biology.
Source: Popkin et al. (2012).
Biology
Technology
Sweet preferences
Cheap caloric beverage revolution
Thirst and hunger/satiety mechanisms not linked
Caloric beverage revolution
Fatty food preference
Edible oil revolution – high‐yield oilseeds, cheap removal of oils
Desire to eliminate exertion
Technology in all phases of movement/exertion
Cardiovascular Disease: Epidemiology and Impact of Modern Lifestyle
CVDs include ischemic heart disease (IHD), stroke, heart failure and peripheral arterial disease, and a number of cardiac and vascular conditions, such as cerebrovascular disease, rheumatic heart disease, and congenital heart disease. It has been estimated that heart attacks and strokes account for over 85% of CVD death events. The events themselves are generally acute in nature and result from an obstruction of blood flow to the heart or brain due to the chronic accumulation of lipid deposition on the inner walls of the blood vessels. In addition, strokes can also occur as a consequence of a brain blood vessel bleeding or because of the presence of blood clots.
CVDs have emerged as the primary cause of death around the globe. According to the 2019 Heart Disease and Stroke Statistics report from the American Heart Association, someone dies of CVD every 38 seconds. Nearly 80% of premature deaths, i.e., death events among people under 70 years old, have been recorded in low‐to‐middle‐income countries, with 37% being attributed to CVDs. Underdeveloped or developing countries suffer high rates of CVD mortality, whereas high‐income industrialized countries and some regions in Latin America show the lowest CVD mortality.
Key Point
CVD burden can be attributed to modifiable risk factors such as diet, exercise, tobacco smoking, obesity, hypertension, dyslipidemia, diabetes mellitus, and alcohol consumption.
Similar to other major NCDs, CVD burden can be attributed to modifiable risk factors such as unhealthy diet, sedentariness, tobacco smoking, obesity, hypertension, dyslipidemia, T2DM, and excessive alcohol consumption. The variation in the presence of those lifestyle risk factors between countries may explain the difference in CVD burden observed among the countries.
Diabetes Mellitus: Epidemiology and Impact of Modern Lifestyle
According to the WHO, diabetes mellitus is defined as “a metabolic disorder of multiple etiology, characterized by chronic hyperglycemia (high blood sugar) with disturbances of carbohydrate, fat, and protein metabolism resulting from defects in insulin secretion, insulin action, or both.” Diabetes mellitus is classified into type 1 (T1DM; insulin‐dependent) and type 2 diabetes mellitus (T2DM; non‐insulin‐dependent or adult‐onset). While the main feature of T1DM is the defective production of insulin (by the pancreas) and the requirement of daily administration of insulin, T2DM is characterized by inefficient use of insulin from the body.
T1DM cannot be prevented, and we still do not fully understand what causes the disease. Furthermore, it is still under investigation whether environmental factors could trigger the destruction of the body's insulin‐producing cells. On the other hand, T2DM development and progression are affected by genetic and environmental factors; exposure to an obesogenic environment, characterized by sedentary behavior, increased stress, and excessive energy consumption, is known to exert an effect on preexisting genetic factors.
