Textbook of Lifestyle Medicine - Labros S. Sidossis

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physically active, maintaining a healthy weight, not smoking or drinking excess amounts of alcohol, controlling stress, and resting adequately.

       To maintain a healthy weight means to have a weight that does not cause illness or functional impairment and promotes a healthy self‐esteem and a positive body image.

       Avoiding tobacco use is undoubtedly beneficial for health. Quitting smoking/tobacco use can also reduce the risk of developing smoking‐related diseases.

       According to WHO, there is no specific limit for alcohol consumption; the less you drink the better it is for your health.

       Adequate sleep (i.e. 7 to 9 hours of sleep for adults) is associated with low mortality and morbidity.

       Stress‐reduction approaches, such as mindfulness‐based stress‐reduction, yoga, and behavioral stress management programs, have all been proven effective in attenuating negative thoughts and feelings of anxiety.

      Self‐Assessment Questions

      1 The term healthy lifestyle:refers to the avoidance of harmful habits, such as smokingincludes behaviors that positively affect the physical aspect of health, such as physical activity and healthy dietencompasses behaviors that affect overall health and wellnessis associated with the prevention of negative health consequences but also the promotion of positive onesall of the above

      2 What are the main principles of a healthy lifestyle?

      3 What are the factors that affect the quality of our diet?

      4 Please define the term “physical activity” and give examples of a few types of physical activity.

      5 How can alcohol cause cancer?

      6 Describe the relationship between alcohol consumption and ischemic heart disease.

      7 How is sleep related to health?

      8 Which of the following statements about smoking are true?Smoking cessation is associated with increased risk for lung cancer ( ).Refraining from smoking is an important part of a heathy lifestyle ( ).Quitting smoking can reduce the risk of developing smoking‐related diseases ( ).Passive smoking has no effect on health ( ).

      1 Aljawarneh, Y.M., Al‐Qaissi, N.M., and Ghunaim, H.Y. (2020). Psychological interventions for adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes: a systematic review. World J. Pediatr. 16 (5): 456–470.

      2 American Psychological Association. (2017). Stress effects on the body. http://www.apa.org/helpcenter/stress‐body.aspx.

      3 Antoni, M.H. and Dhabhar, F.S. (2019). The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer 125 (9): 1417–1431.

      4 Cancer Research UK. (2018). Alcohol and cancer. https://www.cancerresearchuk.org/about‐cancer/causes‐of‐cancer/alcohol‐and‐cancer.

      5 Ghazavi, Z., Rahimi, E., Yazdani, M., and Afshar, H. (2016). Effect of cognitive behavioral stress management program on psychosomatic patients' quality of life. Iran J. Nurs. Midwifery Res. 21 (5): 510–515.

      6 Jimenez‐Ruiz, C.A., Andreas, S., Lewis, K.E. et al. (2015). Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur. Respir. J. 46 (1): 61–79.

      7 Li, Y., Pan, A., Wang, D.D. et al. (2018). Impact of healthy lifestyle factors on life expectancies in the US population. Circulation 138 (4): 345–355.

      8 Manigault, A.W., Shorey, R.C., Hamilton, K. et al. (2019). Cognitive behavioral therapy, mindfulness, and cortisol habituation: a randomized controlled trial. Psychoneuroendocrinology 104: 276–285.

      9 Marteau, T.M. (2018). Changing minds about changing behaviour. Lancet 391 (10116): 116–117.

      10 Roerecke, M. and Rehm, J. (2014). Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta‐analyses and a systematic review and meta‐analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Med. 12: 182.

      11 Sala‐Vila, A., Estruch, R., and Ros, E. (2015). New insights into the role of nutrition in CVD prevention. Curr. Cardiol. Rep. 17 (5): 26. doi: 10.1007/s11886‐015‐0583‐y.

      12 Shield, K., Manthey, J., Rylett, M. et al. (2020). National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study. Lancet Public Health 5 (1): e51–e61.

      13 Willett, W., Rockstrom, J., Loken, B. et al. (2019). Food in the Anthropocene: the EAT‐Lancet Commission on healthy diets from sustainable food systems. Lancet 393 (10170): 447–492. doi: 10.1016/S0140‐6736(18)31788‐4.

      14 Willett, W.C. and Stampfer, M.J. (2013). Current evidence on healthy eating. Annu. Rev. Public Health 34: 77–95. doi: 10.1146/annurev‐publhealth‐031811‐124646.

      15 World Health Organization. (2020). A healthy lifestyle. www.euro.who.int/en/health‐topics/disease‐prevention/nutrition/a‐healthy‐lifestyle.

      16 Yu, E., Rimm, E., Qi, L. et al. (2016). Diet, lifestyle, biomarkers, genetic factors, and risk of cardiovascular disease in the Nurses’ Health Studies. Am. J. Public Health 106 (9): 1616–1623. doi: 10.2105/AJPH.2016.303316.
UNIT II Healthy Diets

      Nutrition epidemiology examines the correlations between dietary patterns, human health, and disease occurrence. In the past, the focus was on the effects of essential nutrient deficiency on health, since most diseases arose from malnutrition or “defective nourishment,” e.g., ascorbic acid deficiency causing scurvy and deficiency of the B‐complex vitamins causing pellagra and beriberi. However, nowadays most major diseases in the developed countries are lifestyle‐related chronic diseases – heart disease, cancer, diabetes, etc. These diseases, unlike nutritional deficiencies, have a chronic development or result from a relatively short exposure to etiological factor(s) that may have occurred many years before diagnosis. Furthermore, they may not be reversible and they don't have single specific etiologic pathways.

      Even though observational studies have suggested a link between specific nutrients and development of chronic diseases, clinical intervention studies do not confirm these associations. The reason may be that nutrients are ingredients of foods, and other aspects of the diet may confound the observed associations. Furthermore, it appears that examining the relationship between a single dietary factor and disease is not enough, since chronic diseases have multiple causes, including genetic makeup and occupational and other lifestyle factors. These factors act either independently or in sync with each other to affect our health. Therefore, examining whole food classes, whole diets or dietary patterns, and, lately, lifestyle patterns is more appropriate in order to investigate positive or negative effects on the development of specific chronic diseases.

       Key Point

      Examining the relationship between a single dietary factor and disease is not enough.

      In the following sections, we will review the progression from single nutrients to dietary and lifestyle patterns.

      The interest in the metabolic effect of food ingredients on the human body dates back to the nineteenth century. In his lecture “Disorders resulting from defective nutriment” given in 1842, George Budd noted, “There is

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