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Chapter 11 - Healthy Eating

from Section 3 - The Lifestyle Medicine Pillars

Published online by Cambridge University Press:  01 May 2025

By
Sumantra Ray ,
Breanna Lepre ,
Federica Amati  and
Lauren Ball
Edited by
Richard Pinder ,
Christopher-James Harvey  and
Ellen Fallows
Richard Pinder
Affiliation:
Imperial College of Science, Technology and Medicine, London
Christopher-James Harvey
Affiliation:
Imperial College of Science, Technology and Medicine, London
Ellen Fallows
Affiliation:
British Society of Lifestyle Medicine
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Summary

Suboptimal diet is a major risk factor for health issues and early mortality globally. Diets like the Mediterranean, DASH, and whole-food plant-based are associated with improved health and disease prevention. It’s crucial to assess dietary quality and nutritional status during clinical consultations using brief validated tools. Dietary habit improvements can be achieved through medical consultations with time and follow-up. The most effective way to promote healthy eating at a population level is through Public Health policies. Nutrition research has advanced from focusing on calories to understanding food quality, processing, and the role of phytoactive substances. Large-scale studies have established associations between diet and health outcomes, despite challenges in proving causality. High-quality trials such as DASH and Lyon Diet Heart Study have shown the benefits of specific dietary patterns on health. Tailoring dietary advice to individual characteristics can motivate healthier eating habits. Discussing dietary habits in clinical consultations should be sensitive to cultural, social, and financial determinants.

Keywords

Lifestyle MedicineDietary patternsNutritional assessmentChronic diseaseMediterranean dietPlant-based dietsPublic healthNutrition researchDASH dietEating habits
Type
Chapter
Information
Essential Lifestyle Medicine , pp. 102 - 121
Publisher: Cambridge University Press
Print publication year: 2025

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References

Willett, W., Rockstrom, J., Loken, B. et al, Food in the Anthropocene: The EAT – Lancet Commission on healthy diets from sustainable food systems. The Lancet. 2019;393(10170):447–492.Google ScholarPubMed
GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016. The Lancet. 2016;390:1345–1422.Google Scholar
Lepre, B., Mansfield, K. J., Ray, S., et al., Reference to nutrition in medical accreditation and curriculum guidance: A comparative analysis, BMJ Nutr Prev Health. 2021;bmjnph-2021-000234 . https://doi.org/10.1136/bmjnph-2021-000234.CrossRefGoogle Scholar
Crowley, J. and Ball, J. H., Nutrition in medical education: A systematic review. September 2019;3(9):E379–E389. https://doi.org/10.1016/S2542-5196(19)30171-8.Google ScholarPubMed
Godlee, F., Nutrition matters. BMJ. 2014;349:g7255. https://doi.org/10.1136/bmj.g7255.CrossRefGoogle Scholar
Hu, F. B. and Willett, W. C., Diet and coronary heart disease: Findings from the Nurses’ Health Study and Health Professionals’ Follow-up Study. J Nutr Health Aging. 2001;5(3):132–138. PMID: 11458281.Google ScholarPubMed
The Million Women Study – Cancer Epidemiology Unit (CEU) (ox.ac.uk).Google Scholar
Orlich, M. J., Singh, P. N., Sabate, J., et al., Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern. Med. 2013;173(13):1230–1238.CrossRefGoogle ScholarPubMed
Yusuf, S., Hawken, S., Ounpuu, S., et al., INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet. 11–17 September 2004;364(9438):937–952. https://doi.org/10.1016/S0140-6736(04)17018-9. PMID: 15364185.CrossRefGoogle Scholar
O’Donnell, M. J., Chin, S. L., Rangarajan, S., et al., Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. Lancet. 20 August 2016;388(10046):761–775. https://doi.org/10.1016/S0140-6736(16)30506-2. Epub 16 July 2016. PMID: 27431356.Google ScholarPubMed
Publications (epic-norfolk.org.uk).Google Scholar
The Seven Countries Study – The first epidemiological nutrition study, since 1958.Google Scholar
Appel, L. J., Moore, T. J., Obarzanek, E. et al., A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336(16):1117–1124.CrossRefGoogle ScholarPubMed
Howard, B. V., Van Horn, L., Hsia, J., et al., Low-fat dietary pattern and risk of cardiovascular disease: The women’s health initiative randomized controlled dietary modification trial. JAMA. 8 February 2006;295(6):655–666. https://doi.org/10.1001/jama.295.6.655. PMID: 16467234.CrossRefGoogle ScholarPubMed
Beresford, S. A., Johnson, K. C., Ritenbaugh, C., et al., Low-fat dietary pattern and risk of colorectal cancer: The women’s health initiative randomized controlled dietary modification trial. JAMA. 8 February 2006;295(6):643–654. https://doi.org/10.1001/jama.295.6.643. PMID: 16467233.CrossRefGoogle ScholarPubMed
De Lorgeril, M., Salen, P., Martin, J.L., Monjaud, I., Delaye, J., Mamelle, N., Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–785.CrossRefGoogle ScholarPubMed
Knowler, W. C., Barrett-Connor, E., Fowler, S. E., et al., Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 7 February 2002;346(6):393–403. https://doi.org/10.1056/NEJMoa012512. PMID: 11832527; PMCID: PMC1370926.Google ScholarPubMed
Obarzanek, E., Kimm, S. Y., Barton, B. A. et al., Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: Seven-year results of the Dietary Intervention Study in Children (DISC). Pediatrics. 2001;107(2): 256–264.Google ScholarPubMed
www.who.int/news-room/fact-sheets/detail/healthy-diet.Google Scholar
Thorning, T. K., Bertram, H. C., Bonjour, J-P, et al., Whole dairy matrix or single nutrients in assessment of health effects: Current evidence and knowledge gaps. Am J Clin Nutr. 2017;105(5):1033–1045.Google ScholarPubMed
Monteiro, C. A., Cannon, G., Moubarac, J-C, et al., The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018;21:5–17.Google ScholarPubMed
Hu, F. B, Dietary pattern analysis: A new direction in nutritional epidemiology. Curr Opin Lipidol. February 2002;13(1):3–9. https://doi.org/10.1097/00041433-200202000-00002.CrossRefGoogle ScholarPubMed
National Diet and Nutrition Survey – GOV.UK (www.gov.uk).Google Scholar
Martinez-Lacoba, R., Pardo-Garcia, I. and Amo-Saus, E., Francisco Escribano-Sotos, Mediterranean diet and health outcomes: A systematic meta-review. Eur J Public Health. October 2018;28(5):955–961. https://doi.org/10.1093/eurpub/cky113.Google ScholarPubMed
Estruch, R., Ros, E., Salas-Salvadó, J., et al., Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 21 June 2018;378(25):e34. https://doi.org/10.1056/NEJMoa1800389.Google ScholarPubMed
Sarsangi, P., Salehi-Abargouei, A., Ebrahimpour-Koujan, S., Esmailzadeh, A., Association between adherence to the Mediterranean diet and risk of type 2 diabetes: An updated systematic review and dose – response meta-analysis of prospective cohort studies. Adv Nutr. 2022 13(5):1787–1798.Google Scholar
Loughrey, D. G., Lavecchia, S., Brennan, S., Lawlor, B. A., Kelly, M. E., The impact of the Mediterranean diet on the cognitive functioning of healthy older adults: A systematic review and meta-analysis. Adv Nutr. 2017;8(4):571–586.CrossRefGoogle ScholarPubMed
Schwingshackl, L., Schwedhelm, C., Galbete, C. and Hoffmann, G., Adherence to Mediterranean diet and risk of cancer: An updated systematic review and meta-analysis. Nutrients. 2017;9(10):1063. https://doi.org/10.3390/nu9101063.Google ScholarPubMed
Eleftheriou, D., Benetou, V., Trichopoulou, A., La Vecchia, C. and Bamia, C., Mediterranean diet and its components in relation to all-cause mortality: Meta-analysis. Br J Nutr. 2018;120(10):1081–1097. https://doi.org/10.1017/S0007114518002593.Google ScholarPubMed
The Eatwell Guide – GOV.UK (www.gov.uk).Google Scholar
Scheelbeek, P., Green, R., Papier, K., et al., Health impacts and environmental footprints of diets that meet the Eatwell Guide recommendations: Analyses of multiple UK studies. BMJ Open. 2020;10(8):e037554.Google ScholarPubMed
Huang, T., Yang, B., Zheng, J., et al., Cardiovascular disease mortality and cancer incidence in vegetarians: A meta-analysis and systematic review. Ann Nutr Metab. 2012;60(4):233–240. https://doi.org/10.1159/000337301.Google ScholarPubMed
Qian, F., Liu, G., Hu, F. B., Bhupathiraju, S. N., Sun, Q.. , Association between plant-based dietary patterns and risk of type 2 diabetes: A systematic review and meta-analysis. JAMA Intern Med. 2019;179(10):1335–1344.Google ScholarPubMed
Neufingerl, N. and Eilander, A., Nutrient intake and status in adults consuming plant-based diets compared to meat-eaters: A systematic review. Nutrients. 2021;14(1):29.CrossRefGoogle ScholarPubMed
Willcox, D. C., Scapagnini, G. and Willcox, B. J., Healthy aging diets other than the Mediterranean: A focus on the Okinawan diet. Mech Ageing Dev. March–April 2014;136–137:148–162. https://doi.org/10.1016/j.mad.2014.01.002.CrossRefGoogle Scholar
Willett, W., Rockström, J. and Loken, B, Food in the Anthropocene: The EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2 February 2019;393(10170):447–492. https://doi.org/10.1016/S0140-6736(18)31788-4.CrossRefGoogle ScholarPubMed
Roehl, K. and Sewak, S. L., Practice paper of the academy of nutrition and dietetics: Classic and modified ketogenic diets for treatment of epilepsy. J Acad Nutr Diet. 2017;117:1279–1292. https://doi.org/10.1016/j.jand.2017.06.006.CrossRefGoogle Scholar
Bueno, N. B., de Melo, I. S., de Oliveira, S. L. and da Rocha Ataide, T., Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: A meta-analysis of randomised controlled trials. Br J Nutr. 2013;110:1178–1187. https://doi.org/10.1017/S0007114513000548.Google ScholarPubMed
Parry‐Strong, A., Wright-McNaughton, M., Weatherall, M. et al., Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials. Diabetes, Obes. Metab. 2022;24(12):2431–2442.Google ScholarPubMed
Sacks, F. M., Lichtenstein, A. H., Wu, J. H. Y., et al., Dietary fats and cardiovascular disease: A presidential advisory from the American Heart Association. Circulation. 2017;136:e1–e23. https://doi.org/10.1161/CIR.0000000000000510.CrossRefGoogle ScholarPubMed
Evert, A. B., Dennison, M., Gardner, C. D., et al., Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care. May 2019;42(5):731–754. https://doi.org/10.2337/dci19-0014.CrossRefGoogle ScholarPubMed
St-Onge, M. P., Ard, J., Baskin, M. L., et al., American Heart Association obesity committee of the council on lifestyle and cardiometabolic health; council on cardiovascular disease in the young; council on clinical cardiology; and stroke council. Meal timing and frequency: Implications for cardiovascular disease prevention: A scientific statement from the American Heart Association. Circulation. 28 February 2017;135(9):e96–e121. https://doi.org/10.1161/CIR.0000000000000476.Google Scholar
Kashyap, A., Mackay, A., Carter, B., et al., Investigating the effectiveness of very low-calorie diets and low-fat vegan diets on weight and Glycemic markers in type 2 diabetes mellitus: A systematic review and meta-analysis. Nutrients. 2022;14(22):4870.Google ScholarPubMed
Ordovas, J. M., Ferguson, L. R., Tai, E. S and Mathers, J. C., Personalised nutrition and health. BMJ. 2018;361:bmj.k2173. https://doi.org/10.1136/bmj.k2173.Google ScholarPubMed
Celis-Morales, C., Livingstone, K. M., Marsaux, C. F., et al., Effect of personalized nutrition on health-related behaviour change: Evidence from the Food4Me European randomized controlled trial. Int J Epidemiol. 2017;46:578–588. https://doi.org/10.1093/ije/dyw186.Google ScholarPubMed
Westbury, S., Oyebode, O., van Rens, T., Barber, T. M., Obesity stigma: Causes, consequences, and potential solutions. Curr Obes Rep. 2023;12(1):10–23.CrossRefGoogle ScholarPubMed
Vallis, M., Piccinini-Vallis, H., Sharma, A. M., Freedhoff, Y.. Modified 5 As: Minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013;59(1):27–31.Google ScholarPubMed
Ball, L., Johnson, C., Desbrow, B., Leveritt, M.. General practitioners can offer effective nutrition care to patients with lifestyle-related chronic disease. J Prim Health Care. 2013;5(1):59–69.CrossRefGoogle ScholarPubMed
Miller, V., Webb, P., Micha, R. et al., Defining diet quality: A synthesis of dietary quality metrics and their validity for the double burden of malnutrition. Lancet Planet. Health. 2020;4(8):e352–e370.Google ScholarPubMed
Biró, G., Hulshof, K., Ovesen, L., et al., Selection of methodology to assess food intake. Eur J Clin Nutr. 2002;56(Suppl 2):S25–S32. https://doi.org/10.1038/sj.ejcn.1601426.Google ScholarPubMed
www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition.Google Scholar
https://epi.grants.cancer.gov/asa24/.Google Scholar
www.dietid.com/.Google Scholar
www.myfood24.org/solutions/health.Google Scholar
www.fns.usda.gov/healthy-eating-index-hei.Google Scholar
www.cardiacrehabilitation.org.uk/docs/Mediterranean-Diet-Score.pdf.Google Scholar
Guthrie, J. F and Morton, J. F, Food sources of added sweeteners in the diets of Americans. J Am Diet Assoc. 2000;100:43–51.CrossRefGoogle ScholarPubMed
Malik, V. S., Schulze, M.B., Hu, F.B.. Intake of sugar-sweetened beverages and weight gain: A systematic review. Am J Clin Nutr. August 2006;84(2):274–288.Google ScholarPubMed
Lohner, S., Kuellenberg, D. de Gaudry, I. Toews, T. Ferenci, Meerpohl, J. J., Non‐nutritive sweeteners for diabetes mellitus. Cochrane Database Syst. Rev. 2020;5: CD012885.Google ScholarPubMed
Rios-Leyvraz, M., Montez, J. and World Health Organization, Health effects of the use of non-sugar sweeteners: A systematic review and meta-analysis. 2022.Google Scholar
Aspartame hazard and risk assessment results released (who.int).Google Scholar
Wilhelmi de Toledo, F., Grundler, F, Bergouignan, A., Drinda, S. and Michalsen, A, Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects. PLoS ONE. 2019;14(1):e0209353.CrossRefGoogle Scholar
Mattson, M. P., Longo, V. D., and Harvie, M., Impact of Intermittent Fasting on health and disease processes. Ageing Research Reviews. 2017;39:46–58.Google ScholarPubMed
Arble, D. M., Bass, J., Laposky, A. D., Vitaterna, M. H and Turek, F. W., Circadian timing of food intake contributes to weight gain. Obesity (Silver Spring). 2009;17(11):2100–2102.CrossRefGoogle ScholarPubMed
Zarrinpar, A, Chaix, A. and Panda, S., Daily eating patterns and their impact on health and disease. Trends Endocrinol Metab. 2016;27(2):69–83.CrossRefGoogle ScholarPubMed
Moro, T., Tinsley, G., Bianco, A. et al., Effects of 8 weeks of time-restricted feeding on basal metabolism, maximal strength, body composition, inflammation and cardiovascular risk factors in resistance-trained males. J Transl. Med. 2016;14:290.CrossRefGoogle ScholarPubMed
Sutton, E. F, Beyl, R., Early, K. S., et al., Early time-restricted feeding improves insulin sensitivity, blood pressure and oxidative stress even without weight loss in men with pre-diabetes. Cell Metab. 2018;27:1212–1221.CrossRefGoogle Scholar
Bo, S, Musso, G, G. Beccuti, et al., Consuming more of daily caloric intake at dinner predisposes to obesity. A 6-year population-based prospective cohort study. PLoS One. 2014;9(9):e108467.CrossRefGoogle ScholarPubMed
Wells, J. C., Sawaya, A. L, Wibaek, R., et al., The double burden of malnutrition: Aetiological pathways and consequences for health. The Lancet. 2020;395(10217):75–88.CrossRefGoogle ScholarPubMed
Barazzoni, R. and Cappellari, G. Gortan, Double burden of malnutrition in persons with obesity. Rev Endocr Metab Disord. 2020;21:307–313. https://doi.org/10.1007/s11154-020-09578-1.CrossRefGoogle ScholarPubMed
Jensen, G. L., Mirtallo, J., Compher, C., et al., International Consensus Guideline Committee. Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr. March–April 2010;34(2):156–159. https://doi.org/10.1177/0148607110361910.Google ScholarPubMed
Fact sheets – Malnutrition (who.int).Google Scholar
Sharma, A. M. and Kushner, R. F., A proposed clinical staging system for obesity. Int J Obesity. 2009;33:289–295.Google ScholarPubMed
Wakeman, M. P., A review of the effects of oral contraceptives on nutrient status, with especial consideration to folate in UK. J Adv Med. 2019;30(2):1–17.Google Scholar
Hickson, M., Child, J. and Collinson, A., Impact of a dietician in general practice: Care of the frail and malnourished. J Hum Nutr Diet. February 2022;35(1):145–153. https://doi.org/10.1111/jhn.12942. Epub 5 September 2021. PMID: 34482578.Google ScholarPubMed
Parks, K. and Polak, R., Culinary medicine: Paving the way to health through our forks. Am J Lifestyle Med. 2020;14(1):51–53.CrossRefGoogle ScholarPubMed
Lean, M. E. J., Leslie, W. S., Barnes, A. C.. , Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial. The Lancet. 2018;391(10120):541–551.CrossRefGoogle ScholarPubMed
Astbury, N. M., Aveyard, P., Nickless, A., et al., Doctor referral of overweight people to low energy total diet replacement Treatment (DROPLET): Pragmatic randomised controlled trial. BMJ. 2018;362:k3760. https://doi.org/10.1136/bmj.k3760.Google ScholarPubMed

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