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 ( ).
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CHAPTER 5 Progression from Nutrients to Dietary Patterns
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.
Focus on Single Nutrient Deficiencies
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 no subject of more interest to the physiologist or of more practical importance to the physician … than the disorders resulting from defective nourishment.”
In the first half of the twentieth century, scientists extensively studied the effects of single nutrients, mainly vitamins and minerals, on the development of various diseases. This perspective led into a new era in nutritional science and provided a myriad of scientifically based evidence on the effect of macro‐ or micronutrients deficiency or surplus on disease development. An example of a disease caused by a single nutrient deficiency is that of scurvy. Scurvy develops due to ascorbic acid deficiency, and it is accompanied by fatigue, lethargy, and malaise, in the early stages, and myalgia, anemia, depression, poor wound healing, and even death in late stages (Figure 5.1a and b). It is noteworthy that scurvy was the focus of what is considered to be the first controlled clinical trial. Specifically, in 1747, during his service as a physician at the British Royal Navy, James Lind studied the effect of citrus fruits (lemons and oranges) in the treatment of scurvy in British sailors. He noticed that the group allocated to including lemons and oranges in their diet showed significant improvement within a week, while those who didn't receive lemons and oranges did not recover even after 2 weeks.
Furthermore, back in the 1880s, the industrialization of milling was established and the refinement of grains became a common practice, as it increased the storage life of the grains. During the refinement process, the bran and the sperm are removed and hence, B‐complex vitamins, fibers,
