Patient Diet Assessment PDF 2024

Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Patient Diet Assessment PD240 Pediatric Dentistry – Summer Quarter, 2024 OVERVIEW Objectives...

Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Patient Diet Assessment PD240 Pediatric Dentistry – Summer Quarter, 2024 OVERVIEW Objectives........................................................................................................................2 Introduction.....................................................................................................................2-3 NOVA Food Classification System..................................................................................4-7 Macronutrients....................................................................................................................8 Carbohydrates....................................................................................................................8 Functions.................................................................................................................8 Sources.................................................................................................................8-9 Intake Recommendations........................................................................................9 Free Sugars (Added Sugars)..................................................................................9 Proteins..............................................................................................................................10 Functions.................................................................................................................10 Sources...................................................................................................................10 Animal Protein..............................................................................................10 Plant Protein............................................................................................10-11 Intake Recommendations........................................................................................11 Fats.....................................................................................................................................12 Functions.................................................................................................................12 Sources..............................................................................................................12-13 Intake Recommendations........................................................................................14 Water..................................................................................................................................15 Functions................................................................................................................15 Sources....................................................................................................................15 Intake Recommendations........................................................................................15 Consumption of processed and ultra-processed foods and chronic diseases..................16 How to Apply this Information in the Pediatric Clinic.....................................................16-18 Examples of Meals.............................................................................................................19 Best Snacks for Children....................................................................................................21 Conclusions........................................................................................................................21 References....................................................................................................................22-24 © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 1 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 OBJECTIVES The student should be able to: Become familiar with the NOVA food classification system. Become familiar with the term macronutrients and identify them in the patients’ diet. Learn basic concepts about the macronutrients - carbohydrates, protein, and fats and use the information to guide and educate parents and patients to include these nutrients in their daily meals. Learn the role that processed and ultra-processed foods play in the etiology of dental caries and chronic diseases. Identify the unprocessed, processed, and ultra-processed foods in the patients’ diet. Guide and counsel parents and patients by helping them understand the risk associated with the consumption of processed and ultra-processed foods as it relates to dental caries and other chronic diseases. Guide and counsel parents and patients by teaching them to include the required macronutrients in each meal and which foods should be substituted for healthier choices. Recommend healthy snacks for children. Introduction Nutrition is related to the assimilation of foods and its effect on the metabolic functions of the body. Most oral problems (dental decay, periodontal and other oral diseases) have nutritional/dietary implications. Problems in the mouth such as missing teeth, pain and infections can affect the ability to eat, thereby affecting nutritional status. The dietary and nutritional factors can play major roles in causing oral disease or promoting oral health by influencing the oral microbiome, salivary flow rate, oral structure, and tooth development. Intake of refined carbohydrates and consumption of added sugars have been related to increased dental caries risk. The main objective of this handout is to provide our pediatric dental students with basic aspects of nutrition with the goal of assessing the dietary information provided by the parents and patients. Students will identify unprocessed, processed, and ultra-processed foods. They may then educate and guide parents and patients in how to replace processed and ultra-processed foods with healthier choices using the information provided in this handout, as well as the props used in our pediatric dental clinic. Ideally each meal should have unprocessed and minimally processed carbohydrates, protein, and fat. Ideally water should be the drink of choice. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 2 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 This document is the Patient Presentation Worksheet (PPW) that is used in the pediatric clinic for ODTP or recall appointments. The arrow points at the diet section which is the focus of the diet assessment that students will do with the information provided by parents and patients. Enlarged view of the diet section of the PPW © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 3 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Example of the diet intake by one of our students. During the diet assessment, students should identify the macronutrients, unprocessed, minimally processed, processed and ultra-processed foods, Ideally, water should be the drink of choice. NOVA Food Classification System The NOVA food classification system was developed by the Brazilian nutrition researcher Carlos Monteiro. This classification is based on the nature, extent and purpose of food processing instead of food types or nutrients. The ultra-processed products are not modified foods, but industrial formulations of cheap sources that contain dietary energy and nutrients plus cosmetic and other types of additive compounds. They contain little or no whole foods. These products are high in calories and contain large amounts of saturated fats, trans fats, refined starches, free sugars and salt. They are poor sources of protein, dietary fiber and micronutrients. Research conducted on NOVA has reported that ultra-processed products dominate the food supplies of several high-income countries and are becoming ubiquitous in lower-middle income and upper-middle income countries. These products are designed to be highly palatable, convenient, and have low cost. They are often sold in large portion sizes and are aggressively marketed. Research has also showed evidence that ultra-processed items are replacing and displacing minimally processed foods and freshly made dishes and meals, leading to unhealthy dietary patterns and diet related non- communicable diseases such as obesity, hypertension and dyslipidemias. NOVA food groups include Group 1 - Unprocessed or minimally processed foods; Group 2 - Processed culinary ingredients; Group 3 - Processed foods; Group 4 - Ultra-processed foods. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 4 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 NOVA Food Classification System Group 1 Unprocessed Foods Edible parts of plants (fruit, seeds, leaves, stems, roots, tubers) or of or from animals (muscle, fat, eggs, milk), Spring and tap water. Minimally Processed Foods Unprocessed foods altered by industrial processes such as removal of inedible or unwanted parts, drying, powdering, squeezing, crushing, grinding, etc., with no added salt, sugar, oils or fats or other food substances to the original food. Example: fresh or frozen fruits, vegetables, legumes, nuts, grains, seeds, milk, meat, poultry, fish and seafood, herbs. Examples of foods included in group 1 © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 5 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Group 2 Processed Culinary Ingredients Substances obtained directly from group 1 foods or from nature by industrial processes such as pressing, centrifuging, refining, extracting or mining. Used to prepare, season, and cook group 1 foods. Example: vegetable oils, lard, butter, sugar, honey, maple syrup, starches, salt Examples of foods included in group 2 Group 3 Processed Foods Products made by adding salt, oil, sugar or other group 2 ingredients to group 1 foods, using preservation methods such as canning and bottling, and, in the case of breads and cheeses, using non- alcoholic fermentation. Example: Salted, dried, cured, or smoked meats and fish. Fruit in syrup. Canned or bottled vegetables and legumes in brine. Salted or sugared nuts and seeds. Freshly made unpackaged breads and cheeses. Examples of foods included in group 3 © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 6 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Group 4 Ultra-Processed foods Are industrial formulations of substances extracted or derived from foods, that contain little or no whole food in their composition and typically it is added flavorings, dyes, emulsifiers and other additives that modify the sensory attributes of the final product. Example: Carbonated soft drinks, sweet or savory packaged snacks, chocolate, candies, ice-cream. Packaged breads and buns. Margarine and other spreads. Cookies, pastries, cakes, and cake mixes. Breakfast ‘cereals’, ‘cereal’ and ‘energy’ bars. ‘Energy’ drinks, milk drinks, ‘fruit’ yoghurts and ‘fruit’ drinks, ‘cocoa’ drinks, and ‘instant’ sauces. Examples of foods included in group 4 © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 7 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 MACRONUTRIENTS Human nutrition deals with the provision of essential nutrients in food that are necessary to support human life and good health. The necessary nutrients include carbohydrates, lipids, proteins, fiber, minerals, vitamins, and water. Nutrients can be classified as macronutrients and micronutrients. Macronutrients which provide food energy to humans include proteins, fats, and carbohydrates. Micronutrients required in small amounts include minerals and vitamins. Carbohydrates Carbohydrates are sugar molecules that contain carbon, hydrogen, and oxygen. Carbohydrates can be classified according to their structure: monosaccharides, disaccharides, oligosaccharides, and polysaccharides. According to their types, they are classified as simple, which contain one and two sugar molecules, and complex, which contain three or more sugar molecules. They are also classified in sugars, fibers, and starches. Carbohydrates are found in fruits, vegetables, milk products, grains, nuts, seeds, and legumes. Sugars are intrinsic in fruits and milk products. Starches consist of several glucose units linked together. Most starches are broken down to sugars by digestive enzymes in the body, but some starches are resistant to digestive enzymes. Fibers consist of many sugar units bonded together and unlike most starches, these bonds cannot be broken down by digestive enzymes and pass relatively intact into the large intestine. Fiber provides satiety and healthy laxation. Functions Carbohydrates functions include energy production, energy storage, building macromolecules, sparing protein, and assisting in lipid metabolism. They provide glucose for the red blood cells, brain, and central nervous system. Sources Food sources of carbohydrates are fruits, vegetables, whole grains (wheat, rice, quinoa, oats, barley, corn), legumes (beans, garbanzos, lentils), nuts, milk, and seeds. Images showing different types of unprocessed/minimally processed foods containing carbohydrates. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 8 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Dietary sources of carbohydrates. The best sources include unprocessed/minimally processed foods. Intake Recommendations The calculated range for carbohydrates intake according to the Institute of Medicine (IOM) is 45%-65% of energy. Specific carbohydrate recommendations are also typically made based on a g/kg body weight formula. These ranges are 5 to 12 g of carbohydrate/kg body weight. The energy value of digestible carbohydrates is generally accepted as 4 kcal/g for both sugars and starches. For fiber the IOM recommends an intake of 14 grams per 1000 calories. Free Sugars (Added Sugars) Processed Culinary Ingredients - Group 2 Free sugars are any sugars added to foods and beverages by the manufacturer, cook or consumer. It also includes sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. They are called free sugars because they are not inside the cells of the foods we eat. Major sources of free sugars include soft drinks, sports drinks, cakes, cookies, pies, fruit punch, dairy desserts, and candy. In the USA the “added sugars” term is used instead of “free sugars” and 100% fruit juice is not considered an added sugar. The World Health Organization (WHO) strongly recommends decreasing the consumption of free sugars to less that 10% of total energy intake to prevent dental caries and decrease the risk of overweight and obesity. WHO suggests a further reduction of the consumption of free sugars to below 5% of total energy intake to decrease the caries rate, as reported in observational studies on dental caries. It has been suggested that limiting the consumption of sugar sweetened beverages to less than one serving per week (200-350 mL) may be beneficial to decrease the risk of chronic diseases including dental caries. Examples of free sugars. In the USA, the term added sugars is used instead of free sugars. 100% fruit juice is not considered an added sugar in the USA. Example of content of sugars and added sugars in cereals and beverages © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 9 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Proteins Proteins are defined as the building blocks of life and are present in every cell of the human body. The protein structure is formed by a chain of amino acids. The body requires 20 amino acids to function properly. Amino acids are classified as essential, conditional, and nonessential. The essential amino acids need to be consumed in the diet as our body cannot produce them. They are present mostly in animal protein and in lesser amounts in some plant foods. Functions Proteins function as transporters (i.e.: hemoglobin which transports oxygen). Their structural function is present in keratin in hair and collagen and in ligaments and tendons. Proteins function also as messengers as hormones such as insulin, neurotransmitters like dopamine and serotonin and as immunoproteins such as immunoglobulins. Proteins act as catalysts, signal receptors, switches, motors, or tiny pumps in many processes and functions of the human body. Sources of Animal Protein: Food sources of animal protein include dairy, eggs, fish, chicken, turkey, and beef. Dietary sources of animal protein © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 10 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Sources of Plant Protein: Food sources of plant protein include legumes (beans, chickpeas, soybeans, and lentils). Grains (corn, wheat, rice, barley, amaranth, quinoa and buckwheat). Seeds (flax, chia, sunflower, and pumpkin seeds). Nuts (such as almonds, pistachios, and walnuts). Dietary sources of plant protein. Dietary sources of both animal and plant protein. Intake Recommendations The calculated range for protein intake according to the IOM is 10-35% of energy intake. Specific protein recommendations are also typically made based on a g/kg body weight formula. These ranges are 1.2 – 1.8 g/kg body weight depending on age and physical activity. The energy value of protein is generally accepted as 4 kcal/g. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 11 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Fats Dietary fat is a group of compounds which include triglycerides, fatty acids, phospholipids and sterols. The main source of dietary fats are triglycerides. Fats can be grouped as saturated fats, trans fats, and unsaturated fats (monounsaturated and polyunsaturated fats). Functions Used for storage of energy in adipose tissue, provide protection to internal organs, insulate against heat loss, serve as structural components of cell membranes, are signaling molecules and they help with the absorption of fat-soluble vitamins (A, D, E, K). In the diet, fats contribute to the taste, texture, and energy content of food. Sources Saturated fats Foods sources of saturated fats include beef, bacon, cheese, ice cream. coconut oil, and palm oil. Examples of foods containing saturated fats. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 12 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Trans fats: The main sources of trans fats in foods are cakes, cookies, pies, fried foods, stick margarine, doughnuts, microwave popcorn, nondairy coffee creamer, among others. A small proportion of trans fats come from ruminant animal products, such as milk and meat, but most of these fats are the result of the partial hydrogenation of plant oils. Examples of foods containing trans fats. Monounsaturated fats Food sources of monounsaturated fats include olive, peanut and canola oils, avocados, almonds, hazelnuts, pecans, pumpkin, and sesame seeds. Example of monounsaturated fats. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 13 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Polyunsaturated fats Food sources of polyunsaturated fats include sunflower, soybean, and canola oils, walnuts, flaxseed, and fish. Examples of food sources of polyunsaturated fats. Best dietary sources of fats. Intake recommendations The calculated range for fats intake is 20-30% of energy. 1 gram of fat has 9 calories. The healthier source of dietary fats are foods that contain monounsaturated and polyunsaturated fats. Avoid the consumption of trans fat and limit the intake of saturated fats to less than 10% of energy (calories) a day. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 14 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Water Water is essential for life and humans cannot survive many days without it. In infants 75% of their body weight is water and, in the elderly, it is about 55%. Drinkable water may include spring, carbonated, distilled, well, soft or hard. In addition to water as a beverage, we get water from food, fruits, vegetables and from oxidation of macronutrients (metabolic water). Functions Water is a building material due to its presence in each cell, tissue, and compartment of our body. It acts as a solvent for glucose and amino acids. Transports nutrients to cells and removes waste from cells. Helps to regulate body temperature and as a lubricant, forms fluids for the joints, saliva, gastric, intestinal, and respiratory mucus secretion. Water functions also as a shock absorber as it maintains the shape of the cells when we walk or run. It protects the brain and spinal cord. Sources Drinkable water, tea, fruits, vegetables, milk, and foods such as soups, stews. Water Intake Recommendations © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 15 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Tricks to Rethink Your Drink Choose water - A glass of water (tap or unsweetened, bottled, or sparkling) over sugary drinks. Need more flavor? Add berries or slices of lime, lemon, or cucumber to water. Missing fizzy drinks? Add a splash of 100% juice to plain sparkling water for a refreshing, low-calorie drink. Need help breaking the habit? Don’t stock up on sugary drinks. Instead, keep a jug or bottles of cold water in the fridge. Water just won’t do? Reach for drinks that contain important nutrients such a low fat or fat free milk; unsweetened, fortified milk alternatives; or 100% fruit or vegetable juice first. (NOTE: Before infants are 12 months old, do not give fruit or vegetable juice. Juice after 12 months old is not necessary, but 4 ounces or less a day of 100% juice can be provided.) At the coffee shop? Skip the flavored syrups or whipped cream. Ask for a drink with low fat or fat free milk, an unsweetened milk alternative such as soy or almond, or get back to basics with black coffee. At the store? Read the Nutrition Facts label to choose drinks that are low in calories, added sugars, and saturated fat. On the go? Carry a reusable water bottle with you and refill it throughout the day. Still thirsty? Learn how to drink more water. Consumption of processed and ultra-processed foods and their association to oral and chronic diseases Dental caries is the most common chronic disease of childhood despite increased dental visits. Its prevalence remains greater than 40% among children 2 to 19 years of age. Several factors are associated with the risk of developing dental caries. Biological and physical factors for enamel caries include high numbers of cariogenic bacteria, decreased salivary flow, lack of adequate fluoride exposure and genetic factors. Behavioral factors include poor oral hygiene, poor dietary habits such as frequent consumption of refined carbohydrates, frequent use of medications that contain sugars and inappropriate methods of feeding infants. Other factors associated with the risk of dental caries include poverty, education, number of years in education, dental insurance coverage and orthodontic appliances. Consumption of processed and ultra-processed foods have been associated with increased dental decay in children and adolescents. The prevalence of dental caries has been reported to be 70% in children and adolescents consuming ultra-processed foods. In addition to dental caries being the most common disease of childhood, the prevalence of childhood chronic illness in the United States continues to increase, and approximately 1 in 5 children have a chronic illness that affects their daily function. According to the Centers for Disease Control and Prevention (CDC) in the United States, more than 40% of school-aged children and adolescents have at least one chronic health condition, such as diabetes, asthma, and obesity. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 16 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 In particular, chronic diseases are more prevalent in the populations with the lowest socio- economic level. In developing countries chronic diseases are related to a multiple of risk factors, which include consumption of foods high in saturated fats, salt, and added sugars. Several studies have reported that the consumption of processed and ultra-processed foods by children and adolescents is associated with dental caries, overweight, obesity and cardio-metabolic risks and asthma. Other studies have also reported that consumption of ultra-processed foods during peri-pregnancy and pregnancy, especially sweet drinks, have been associated with excessive weight, obesity and altered verbal functioning in early childhood. Other findings reported with eating ultra- processed foods are the presence of depression and difficulties in internalizing and externalizing problems in male adolescents. How To Apply This Information in Our Pediatric Clinic? Complete the diet section in the parent interview section of the patient presentation worksheet. Make sure that you complete this section thoroughly by asking open ended questions and follow-up questions, if not enough information is provided by the parent and patients. Example of a diet intake completed by one of students in the pediatric dental clinic Identify the macronutrients in the diet section of the patient presentation worksheet. C carbohydrates, F fat, P protein. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 17 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Identify the unprocessed, minimally processed, processed and ultra-processed foods reported by the parents and patients. Foods in red font indicate processed and ultra-processed foods and foods in green font indicate unprocessed and minimally processed foods. Discuss with the parent and the child the association of processed and ultra-processed foods and chronic disease – dental caries, obesity, asthma, diabetes. Using the dietary intake reported by the parent and the props available in the pediatric clinic, show parents and patients which are the processed and ultra-processed foods being consumed and give them healthier alternatives. Emphasize the consumption of unprocessed and minimally processed food which include fresh fruits, vegetables, whole grains, legumes, water, nuts, seeds, non-sweetened yogurt, meat, chicken, fish. Limit processed foods while avoiding or using sparingly ultra-processed foods. Make water their drink of choice. The diet reported by the parents and patients as well as the assessment that includes which are the macronutrients present and the types of foods consumed unprocessed, minimally processed, processed and ultra-processed should be documented in the Preventative Treatment Plan in Axium. Example: Breakfast is high in processed and ultra-processed carbohydrates: waffles, pancakes, syrups, rice Krispies cereal. Sodas and juices are ultra-processed foods. Protein is limited to eggs, bacon, cheese, and meat. Sources of fat are mainly saturated, and trans fats present in bacon, cheese, chips, and cookies. Recommendations: include more fruits, vegetables, whole grains, and legumes as carbohydrate containing foods. Eat more variety of protein, fish, chicken, legumes. Choose healthier source of fats, avocado, nuts, and seeds. Snack on fruit, vegetables, nuts, unsweetened yogurt. Drink water throughout the day. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 18 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 The NOVA Food System Classification and the Canada Food guide are useful tools to provide education and guidance to parents and patients. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 19 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Examples of Meals Ideally, every meal should have the three macronutrients reviewed in the lecture, carbohydrates (fruits, vegetables, whole grains and fiber); plant protein (beans, lentils, garbanzos, soy) or animal protein (lean beef, chicken, fish); fats (fatty fish, avocados, nuts, flaxseeds, sunflower and pumpkin seeds). If using oils, use small amounts and preferable use olive oil. The drink of choice should be water. Breakfast Chicken salad with corn, beans and avocado. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 20 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Best Snacks for Children Fruits, vegetables, baked sweet potatoes, unsweetened yogurt, hummus, avocado, salsa, edamame, roasted garbanzos, all types of nuts and pumpkin seeds. Nut butters spread on whole grains cracker or bread, air popped corn, brown rice crackers. Baked tofu slices. Hard boiled eggs. Water. Conclusions The association between processed and ultra-processed foods intake and chronic diseases in children and adolescents has been reported extensively. The role of dental professionals in creating awareness and educating dental patients is very important. However, nutrition education for oral health care providers has failed in several areas including number of hours devoted to teaching, faculty preparation, course content and clinical application and relevance. This handout provides with both educational and practical information for dental students to assess the patients’ diet as reported by the parents and caregivers. Identifying processed and ultra- processed foods and replacing those items with macronutrients (carbohydrates, protein, and fat) derived from unprocessed foods can be a valuable tool in the pediatric dental clinic and in clinical practice. This information may help families to reduce the intake of ultra-processed foods and to increase the consumption of unprocessed or minimally processed foods to improve and enhance children’s health and well-being. Other useful resources to refer parents for more information are: myplate.gov https://food-guide.canada.ca/en/ © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 21 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 References: Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Protein Function. Available from: https://www.ncbi.nlm.nih.gov/books/NBK26911/ Blackwell, C. K., Elliott, A. J., Ganiban, J., Herbstman, J., Hunt, K., Forrest, C. B., Camargo, C. A., Jr, & program collaborators for Environmental influences on Child Health Outcomes (2019). General Health and Life Satisfaction in Children With Chronic Illness. Pediatrics, 143(6), e20182988. https://doi.org/10.1542/peds.2018-2988 Cascaes, A., Silva, N., Fernandez, M., Bomfim, R., & Vaz, J. (2023). Ultra-processed food consumption and dental caries in children and adolescents: A systematic review and meta- analysis. British Journal of Nutrition, 129(8), 1370-1379. doi:10.1017/S0007114522002409 Da Silva, N. R. J., de Camargo, M. B. J., Dos Vaz, J. S., Correa, M. B., Matijasevich, A., da Silva Dos Santos, I., & Cascaes, A. M. (2023). Ultra-processed food consumption and dental caries in adolescents from the 2004 Pelotas Birth Cohort study. Community dentistry and oral epidemiology, 10.1111/cdoe.12851 David M. Krol, Kaitlin Whelan, THE SECTION ON ORAL HEALTH; Maintaining and Improving the Oral Health of Young Children. Pediatrics January 2023; 151 (1): e2022060417. 10.1542/peds.2022-060417 DiMaria-Ghalili, R. A., Mirtallo, J. M., Tobin, B. W., Hark, L., Van Horn, L., & Palmer, C. A. (2014). Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. The American journal of clinical nutrition, 99(5 Suppl), 1184S–93S. https://doi.org/10.3945/ajcn.113.073536 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2022) https://www.cdc.gov/healthyweight/healthy_eating/drinks.html Field, C. J., & Robinson, L. (2019). Dietary Fats. Advances in nutrition (Bethesda, Md.), 10(4), 722–724. https://doi.org/10.1093/advances/nmz052 Fuhrman J. (2018). The Hidden Dangers of Fast and Processed Food. American journal of lifestyle medicine, 12(5), 375–381. https://doi.org/10.1177/1559827618766483 Huang Y, Chen Z, Chen B, Li J, Yuan X, Li J et al. Dietary sugar consumption and health: umbrella review BMJ 2023; 381 :e071609 doi:10.1136/bmj-2022-071609 Khan SY, Holt K, Tinanoff N. Nutrition Education for Oral Health Professionals: A Must, Yet Still Neglected. Journal of Dental Education. 2017 Jan;81(1):3-4. PMID: 28049671. © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 22 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Langyan, S. et al. (2021). Sustaining Protein Nutrition Through Plant-Based Foods. Frontiers in Nutrition. Vol.8, 1-20. https://doi.org/10.3389/fnut.2021.772573 Leonie, E., Machado, P., Zinöcker, M., Baker, P., & Lawrence, M. (2020). Ultra-Processed Foods and Health Outcomes: A Narrative Review. Nutrients, 12(7), 1955. https://doi.org/10.3390/nu12071955 Monteiro, C., Cannon, G., Moubarac, J., Levy, R., Louzada, M., & Jaime, P. (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition, 21(1), 5-17. doi:10.1017/S1368980017000234 Monteiro, C.A., Cannon, G., Lawrence, M., Costa Louzada, M.L. and Pereira Machado, P. 2019. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO. Moynihan P. (2016). Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake. Advances in Nutrition (Bethesda, Md.), 7(1), 149–156. https://doi.org/10.3945/an.115.009365 Noce, A., Romani, A., & Bernini, R. (2021). Dietary Intake and Chronic Disease Prevention. Nutrients, 13(4), 1358. MDPI AG. Retrieved from http://dx.doi.org/10.3390/nu13041358 Popkin, B. M., D'Anci, K. E., & Rosenberg, I. H. (2010). Water, hydration, and health. Nutrition reviews, 68(8), 439–458. https://doi.org/10.1111/j.1753-4887.2010.00304.x Prentice, A. (2005). Macronutrients as sources of food energy. Public Health Nutrition, 8(7a), 932-939. doi:10.1079/PHN2005779 Puig-Vallverdú, J.et al., (2022). The association between maternal ultra-processed food consumption during pregnancy and child neuropsychological development: A population-based birth cohort study. Clinical nutrition (Edinburgh, Scotland), 41(10), 2275–2283. https://doi.org/10.1016/j.clnu.2022.08.005 Reales-Moreno, M., Tonini, P., Escorihuela, R. M., Solanas, M., Fernández-Barrés, S., Romaguera, D., & Contreras-Rodríguez, O. (2022). Ultra-Processed Foods and Drinks Consumption Is Associated with Psychosocial Functioning in Adolescents. Nutrients, 14(22), 4831. https://doi.org/10.3390/nu14224831 Selwitz, R. H., Ismail, A. I., & Pitts, N. B. (2007). Dental caries. Lancet (London, England), 369(9555), 51–59. https://doi.org/10.1016/S0140-6736(07)60031-2 Slavin, J. & Carlson, J. (2014). Carbohydrates. Advanced Nutrition 5(6): 760-761. https://doi.org/10.3945%2Fan.114.006163 © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 23 of 24 All Rights Reserved Patient Diet Assessment PD240 Pediatric Dentistry - Summer, 2024 Tricks to Rethink your Drink. Centers for Disease Control and Prevention. Water, Hydration, and Health. Nutrition.gov (2022). https://www.cdc.gov/healthyweight/healthy_eating/drinks.html Watford, M., & Wu, G. (2018). Protein. Advances in nutrition (Bethesda, Md.), 9(5), 651–653. https://doi.org/10.1093/advances/nmy027 De Souza, M., Vaz, J., Martins-Silva, T., Bomfim, R., & Cascaes, A. (2021). Ultra-processed foods and early childhood caries in 0–3-year-olds enrolled at Primary Healthcare Centers in Southern Brazil. Public Health Nutrition, 24(11), 3322-3330. doi:10.1017/S1368980020002839 Wang, Y., Guglielmo, D., & Welsh, J. A. (2018). Consumption of sugars, saturated fat, and sodium among US children from infancy through preschool age, NHANES 2009-2014. The American journal of clinical nutrition, 108(4), 868–877. https://doi.org/10.1093/ajcn/nqy168 © 2024 Leticia Mendoza-Sobel, DDS, MS, CNS University of the Pacific, Arthur A. Dugoni School of Dentistry Page 24 of 24 All Rights Reserved