Improving the Consumption of Dietary Fibre - Research Paper Example

Improving consumption of dietary fiber among the population of New South Wales Nutrition Communication Plan Background Dietary fibres are an essential part human diet. It is the indigestible portion of plant based foods which aid to move food through the digestive system by absorbing water. Dietary fiber consists of non-starch polysaccharides and several other plant components such as cellulose, dextrins, insulin, lignin, waxes, chitins, pectins, beta-glucans and oligosaccharides. Cellulose, hemi-cellulose and pectins are components present in the skins of fruits, coverings of seeds and the structural parts of edible plants. Cellulose is not soluble in hot or cold water. Pectins which occur in ripe fruits have the ability to absorb water and to from gels. As a result of this prop­erty of pectins it is commonly used in the preparation of jams and jellies. (Dietary Reference Intakes, 2001). Dietary fiber which are not soluble in water, are classed as insoluble fiber. Water insoluble fibres are found in whole wheat, wheat bran, seeds, nuts and vegetables. On the other hand viscous plant fibres are soluble in water. Examples of soluble fibres include pectins, gums and mucilages. Soluble fibres are found in fruits, oat and barley, legumes and beans. The human body does not have enzymes capable of breaking down cellulose, hemi-cellulose and pectins and so fiber is not digested in the body. However, in view of their ability to absorb water, these indigestible sub­stances serve a useful purpose in helping with the elimination of intestinal wastes. They are responsible for stimulating the peristaltic (rhythmic) movements of the gastrointestinal tract by adding bulk to the intestinal contents. The insoluble fiber needs chewing and may improve mastication of food. Dietary fiber absorbs water, swells and thus increases surface area of the mass (Elkins, 1999). As a result of this property there is increased contact between the food mass and enzymes and hence digestion improves. Adequate amount of fiber in diet also give a feeling of fullness. The sponge like swollen mass of fiber ensures smooth elimination of faeces. Fiber reduces transit time and binds some minerals such as calcium, iron, zinc, etc. Soluble fiber binds bile acids and cholesterol and helps carry these out of the body. There is no recommended dietary allowance for fiber. How­ever, nutritional researchers and dieticians suggest that fiber intake be increased to 25 grams or more per day. There are several sources of dietary fiber. Whole grain cereals, whole wheat flour, fruits such as apples with their skin, bananas, pineapple, vegetables such as cabbage, greens are all good sources of fiber. Unusual sources include agar-agar obtained from sea weed. As has already been described, these groups of substances are not digestible and do not contribute any nutrients to the body. Since there is no recommended daily allowance, the exact amount of fiber needed by the human body can­not be stated. Some experts feel 100 mg fiber per kg or about five to six grams per day is sufficient for the adult. An average mixed diet consisting of a raw vegetable, fresh fruit with skins, cooked fruits, and vegetables will usually pro­vide sufficient fiber. Fiber content in the diet can be increased by use of some whole grain cereals or whole wheat bread. Food preparations made from whole wheat flour are also a good source of fiber. Target consumer group Vegetables and fruit in particular have attracted the attention of the scientific community for their cancer protective effects. As a result of this many cancer associations around the world, together with a number of National Dietary Guideline committees have recommended a daily intake of 5-7 servings of vegetables and fruits to reduce cancer risk. According to the Food and Drug Administration, have formally acknowledged the protective effect by approving a health claim to the effect that diets low in fat and rich in vegetables and fruit may reduce the risk of some cancers (US Food and Drug Administration, 1998). Australia has one of the highest bowel cancer incidence rates in the world. Each week about 90 Australians die from bowel cancer. According to the prediction of New South Wales (NSW) Cancer Plan 2007 -2010 it is estimated that over 1600 people would die of bowel cancer every year and only 65 percent will live for more than 5 years beyond their diagnosis (Tracey et al, 2006). Bowel cancer is the most common internal malignancy affecting both the gender in Australia. The incidence begins to rise after the age of 50 with a sharp and continuing increase thereafter. It is suggested that 11 percent of cancers in Australians are attributable to low consumption of vegetables and fruit (Mathers, et al. 1999). The protective effects of vegetables and fruit against cancers, as well as other diseases such as coronary heart disease and type 2 diabetes, has led to the promotion of vegetables and fruit consumption as a national public health priority (SIGNAL, 2003). A case control study pointed to dietary fiber, vitamin C, folate, and lycopene as protective 14; a meta-analysis of 26 studies found B-carotene and vitamin C protective (Gandini et al. 2000); and another case control study found carrots and raw vegetables protective (Franceschi and Favero, 1999). Survival of individuals with bowel cancer is stage-specific. For instance, with cancers confined to the bowel wall (Australian Clinico Pathological Stage [ACPS] A) have 87 percent five year survival, in cases where cancers are penetrating the bowel wall (ACPS B) 75 percent survival is reported, those involving lymph nodes (ACPS C) 40 percent and distant organs (ACPS D) 8 percent survival is reported (South Australian hospital-based registries 1987-1995). Detection of the disease at an early pathological stage provides substantial improvement in survival for the individual and decreases mortality from the disease in the community. The prognosis for bowel cancer patients is relatively good compared to other cancers such as lung (where mortality is 87 percent of incidence rate) and stomach (81 percent) (Fleming, 2002). There have been marginal increases in the incidence of bowel cancer among both males and females between 1990 and 1996, an annual average of 1.0 percent and 0.2 percent respectively. In 1997, incidence in males dropped slightly and in females there was a sharper rise. In comparison mortality rates have fallen slightly but steadily, which is good news. There are also studies that suggest that development of cancer after a certain age increases. Persons who are aged 50 years or more, and have no symptoms of bowel cancer and no special risk factors, are classified as being at average risk for developing bowel cancer. At 50 years of age, the chance of developing symptomatic bowel cancer over the next 5 years is about 1 in 300, where as at age of 60, the chance of developing symptomatic bowel cancer over the next 5 years is about 1 in 100 (AIHW, 1996). A person who has extensive and longstanding ulcerative colitis or Crohn’s disease involving the colon and most people who have had colorectal tumours removed, (Bülow and Swendsen, 1990; Atkin et al, 1992) is also at above average risk of developing bowel cancer. Besides, individuals with a family history of bowel cancer also have an above average risk of developing bowel cancer (John et al, 1993). Additionally, obesity and diets high in fats, red or processed meats, tobacco consumption or heavy alcohol consumption can also increase the risk of developing bowel cancer. Physical activity and diets rich in fruit, vegetables, cereals and whole grains are protective factors from this (Tracey et al, 2006). Nutritional Benefits of Dietary Fiber Balanced diet aimed at preventing bowel cancer should be high in fiber and low in fat, salt and added sugars containing plenty of fruit, vegetables and starchy foods such as rice, pasta, potatoes and moderate amounts of milk, dairy foods and meat. Estimates suggest that almost 80 percent of cases of bowel cancer may be preventable by eating a minimum of 5 portions of fruit and vegetables a day. Fruit and vegetables contain a wide variety of substances other than fibres known to have health benefits including carotenoids, vitamin C, vitamin E and flavonoids. The vitamins and plant components contain antioxidants that fight against free radicals in the body and protect against cancer (ESO, N.D.). Lack of fiber in the diet usually makes it difficult to eliminate food waste from the body. Consistent shortage of fiber in the diet could lead to constipation and other disturbances of the colon. This condition could be corrected by including foods containing whole grain cereals, fruits with skins and vegetable and fruit salads in the diet. Constipation is a common problem in large percentage of the population. One of the reasons for this condition is the intake of refined foods. An increase in fibre intake helps to correct this ailment. Eating leafy vegetables, cluster beans, etc., has been found to ensure smooth, regular elimination. With regular elimination of softer stools, the formation of hemorrhoids is reduced and diverticulosis is prevented or controlled. Pectins and gums bind bile acids and cholesterol and thus reduce their blood levels. Dietary fibre by increasing bulk and needing more chewing may reduce the food intake. Thus it can help obese persons to reduce total energy intake and lose weight. The carbohydrate absorption is slowed, which helps to regulate blood sugar and lowers insulin need of diabetics. Large soft stools may dilute potential carcinogens. Rapid transit of stools may reduce content of carcinogens in colon mucosa and thus reduce risk of colon cancer. Legal Consideration Under the food product standard of the Australian Food Standards Code (STANDARD 2.1.1) and transitional standards (standard 1.1A.5), the products of cereals and cereal products can not be permitted to address health claims and therapeutic claims, but they are allowed to address nutrition claims including content claims and function claims. Hence fiber content in normal diet cannot be claimed for any health and therapeutic purposes. However, since there are several studies that actually prove the fact that dietary fibres are an essential part of balanced diet, it is important to create an awareness among the population of New South Wales, Australia, where the problems due to its deficiency is clear. Good source of fiber is good for health and high quality fiber, low fat, low sugar, low cholesterol, non-GM food (genetically modified) need to form an essential part diet on a daily bases. Because of the regulation of Food Standard, we can not address health and therapeutic claims on food products. Therefore, we need key third parties to assist in promoting consumption of fiber in order to reduce the rate of bowel cancer in Australia. Promotion plan Awareness need to be created regarding the importance of dietary fiber among the population of New South Wales. For this purpose, I have selected basically two modes – the direct and the indirect communication. Direct communication: Education of dietary fiber intake will be held in the local community hall once a month then for 6 months in succession in one area. Free samples of high fiber diets like whole wheat bread, fruits etc will be provided. In addition, in schools and colleges classes will be conducted to create awareness among children and adolescents. Indirect communication: In this form of communication pamphlets, leaflets and brochures will be distributed at public places like hospitals, shopping malls or supermarkets. This will aid in creating awareness among the general public. Advertising through print, visual and audio media like will be another mode of awareness generation. Television, magazines and website hosting on the importance of dietary fiber will also be done. For all these purposes it is important to have enough funds. The major sources of fund will be the following- The special fund will be subsidized by government of NSW or region and local government and Patronage of fiber products producers and companies. Key organizations or groups to be involved Dieticians Association of Australia (DAA) and food product manufacturers will be the key third parties who are invited to participate in this plan. The main them under which these plans will be carried out will be “consuming fiber in your diet is important for your healthy life.” The dieticians of DAA will teach participants how to improve fiber intake by providing proper plans of foods that contain a balanced amount of all required vitamins, minerals, protein and dietary fibres. A list of foods rich in fiber according to The Australian Guide for Healthy Eating will also be provided to the participants. The Cancer Council, Australia, The Cancer Institute, NSW, Westmead Institute for Cancer Research, NSW and The Gut Foundation will also be the key third parties who will also conduct classes and help the participants to improve their dietary intake of fiber. They will be mainly responsible for explaining the relationship between dietary fiber intake and bowel cancer, the causes and symptoms of bowel cancer and the prevention measures. In Australia, it is estimated that more than 25 per cent of cancer cases and more than 7600 cancer deaths are due to overweight and obesity, physical inactivity, poor diet and drinking alcohol. It has been more than 10 years since Australia has collected information on the eating and exercise habits of adults and children and in this period there have been social, demographic and lifestyle changes that have significantly influenced people’s diets and activity levels. The country has also seen changes in the production, supply and availability of food. Australia, like other developed countries, has seen an increase in levels of overweight and obesity and chronic diseases linked to diet and inactivity, such as cardiovascular disease, hypertension and diabetes. It is important to not that by increasing the amount of good dietary fiber, the problem of overweight and the dangers linked with it can also be reduced. When high dietary fibre foods are eaten, other high calorie foods are either reduced in quantity or completely excluded. For example, diets that are high in fibre tend to be low in energy and these diets can be useful in weight control. There is no recommended dietary intake (RDI) for fibre as such in Australia. However, the Australian Department of Health has among its dietary goals for Australians an increased intake of fruit, vegetables, bread and cereals, all of which are sources of dietary fibre. The greatest amount of dietary fibre in wheat is in the outer layer or bran, of the wheat grain. When white flour is produced, the bran layer is removed and the dietary fibre content of the flour is greatly reduced. Flour made from whole grains contains about three times as much dietary fibre as white flour. It is probably reasonable to aim for a dietary fibre intake of 30grams per day, compared with current intakes in Western countries of about 20 grams per day. Evaluation of the Communications Plan Evaluation of Nutrition Communication Plan The evaluation of direct communication in nutrition education activities 1. The achievement is assessed by a question and answer session both in schools and other places. 2. Questionnaire will be provided at the end of the activity for the purpose of evaluation. Besides, the outcome of the activity will be measured at the end of each activity in order to improve the plan. The evaluation of indirect communication 1. The effectiveness of the materials circulated will be measured through questionnaires or telephonic interview. 2. Investigation about the condition of high fiber foods sold will be done to assess the effectiveness of advertising. Conclusion The nutrition communication plan, improving dietary fiber intake among the population of NSW, is expected to create awareness about high fiber food and bowel cancer among the population of NSW. This plan was developed looking at the fact obtained from a national nutrition survey which gave ample amount of evidence that Australian population was deficient in dietary fiber. As a result of this deficiency Australia is among the most vulnerable countries for cancers. This plan is produced and connects NSW government, region, local government, the third organizations such as The Cancer Council, Australia, The Cancer Institute, NSW, Westmead Institute for Cancer Research, NSW and The Gut Foundation to work together to promote dietary fiber intake among the population in NSW. The plan may be implemented in other states subject to its success in NSW. Executive Summary Dietary fibres are an essential part human diet and are the indigestible portion of plant based foods which aid to move food through the digestive system by absorbing water. In view of their ability to absorb water, these indigestible sub­stances serve a useful purpose in helping with the elimination of intestinal wastes. They are responsible for stimulating the peristaltic movements of the gastrointestinal tract by adding bulk to the intestinal contents. Vegetables and fruit in addition to cereals have high quality and quantity of dietary fiber and are responsible for their cancer protective effects. According to the prediction of New South Wales (NSW) Cancer Plan 2007 -2010 it is estimated that over 1600 people would die of bowel cancer every year and only 65 percent will live for more than 5 years beyond their diagnosis. In addition to cancers, there are also problems of overweight and other health problems related to obesity. Hence it is essential for a proper diet plan including fibres. This nutritional plan is developed to help the general public to increase awareness regarding the intake of dietary fiber and there by decrease the health related problems. Dieticians Association of Australia, The Cancer Council, Australia, The Cancer Institute, NSW, Westmead Institute for Cancer Research, NSW and The Gut Foundation will be the key third parties involved in this project. All these government and non- governmental organization together with educational institutions will work hand in hand to increase the dietary fiber and ultimately reduce bowel cancer and other health problems due to the lack of good fiber. References Atkin, W.S., Morson, B.C. and Cuzick, J. (1992). Long-term risk of colorectal cancer after excision of rectosigmoid adonomas, N Engl J Med;326:658-62. Australian Institute of Health and Welfare (AIHW), Coates M, Jelfs P et al. (1996) Cancer in Australia. 1989 -1990. 5 edn. Canberra: AGPS. Bülow, S., Svendsen, L.B. and Mellemgaard, A. (1990). “Metachronous colorectal carcinoma. Br J Surg, 77:502-5. Dietary Reference Intakes, (2001) Proposed Definition of Dietary Fiber. Institute of Medicine, National Academy Press, Washington D.C. Elkins, R. (1999). Fiber Facts, Woodland Publishing, pp. 23-30. European School of Oncology (ESO), (N.D.) The Facts: Bowel and Colorectal Cancer [Online] Available from: [Accessed on 9 June 2007]. Franceschi, S. and Favero, A. (1999) The role of energy and fat in cancer of the breast and colon-rectum in a southern European population. Ann Oncology; 10: 61-63. Fleming, S. E. (2002). Handbook of Dietary Fiber, American Journal of Clinical Nutrition, Vol. 76, No. 2, p.493. Gandini, S., Merzenich, H., Robertson, C. and Boyle, P. (2000) Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Europ J Cancer; 36(5): 636-46. Mathers C, Vos T, Stevenson C. (1999) The burden of disease and injury in Australia. Australian Institute of Health and Welfare (AIHW), Cat No. PHE 17. AIHW, Canberra. Strategic Intergovernmental Alliance of the National Public Health Partnership (SIGNAL), (2003) Eat Well Australia - An agenda for action for public health nutrition 2000-2010. [Online] Available from [Accessed on 9 June 2007] St. John D.J.B, McDermott, F.T., Hopper, J.L. et al. (1993). Cancer risk in relatives of patients with common colorectal cancer, Ann Intern Med, 118:785-90. Tracey, E.A., Chen, S., Baker, D., Bishop, J., Jelfs, P. (2006). Cancer in New South Wales: Incidence and Mortality 2004. Sydney: Cancer Institute NSW. US Food and Drug Administration, (1998) Staking a claim to good health, FDA Consumer Magazine, Nov/Dec 1998. p 8. Read More