Diet ,Nutrition & Life long Health:Diet ,Nutrition & Life long Health:New opportunities for agriculture New opportunities for agriculture

UNUUNUIUNSIUNS

Ricardo Uauy MD PhDRicardo Uauy MD PhD London School of Hygiene and Tropical Medicine London School of Hygiene and Tropical Medicine

University of London University of London www.lshtm.ac.ukwww.lshtm.ac.uk and and Institute of Nutrition University of Chile Institute of Nutrition University of Chile www.inta.clwww.inta.cl

inta

0

25

50

75

100

20 40 60 80 100

120

Years of Life

1930

19652000

Ideal

Improvements in Life Expectancy

Perc

en

t

140

Future?

inta

Past

% of total DALYs lost

Energy excess

Under nutrition

Cause of Death by WHO region WHR 2002

*

*

**

**

Risks Associated to Global Deaths

2000

(x 000)

* Significantly determined by diet and PA

*

www.who.int/hpr/nutrition/ExpertConsultationGE.htm

Technical Report Series 916

1961

1999

Dietary energy Supply (DES) &

Overweight

Kcal/kg/dDES Kcal/kg/d

%Overweight

50

40

30

20

2400 38003200

Highest QuartileLowest Quartile

% Obesity Prevalence by GNP

GNP US $ per caput GNP US $ per caput

% Obesity by Education & GNP

Monteiro and Popkin 2004

Very poor Poor

More educated

Less educated

Energy Intake

Energy Expenditure

Unlimited Intake

Energy Intake

Energy Expenditure

Limited Intake

Expenditure>Intake Intake>Expenditure

Low Energy Stores (body fat)

Increase in Energy Stores Energy balance established at unhealthy weight.

Primitive Life Modern LifeIncrease

Expenditure

ReduceIntake

YOU CAN ENHANCE YOUR CHANCES FOR A LONG AND HEALTHY LIFE BY CHANGING

YOUR:

MOTHER FATHER DIET and Activity level

Total fatSaturated Fats

(C14,C16) Trans fatty acidsRefined starches Free sugarsSodium/saltPreserved meats

PHYSICAL ACTIVITY Vegetables Fruits, legumesFibre/NSP- 3 fatty acids (EPA+DHA)

Iron/iodine/ZincFolate

Principal nutrient/food Principal nutrient/food changeschanges

Principal nutrient/food Principal nutrient/food changeschanges

IncreaseIncreaseIncreaseIncreaseReduceReduceReduceReduce

Sugars provides empty calories: this means that depending Sugars provides empty calories: this means that depending on how much sugars you consume you may be getting on how much sugars you consume you may be getting insufficient amounts of vitamins and minerals. insufficient amounts of vitamins and minerals.

Sugars please our brain, promote insulin secretion and Sugars please our brain, promote insulin secretion and especially as sweet drinks lead to unbalanced energy intake especially as sweet drinks lead to unbalanced energy intake

Sugars increase energy density of foods may aggravate the Sugars increase energy density of foods may aggravate the metabolic syndrome in people with the metabolic syndrome metabolic syndrome in people with the metabolic syndrome (visceral obesity, diabetes, heart disease, high BP) (visceral obesity, diabetes, heart disease, high BP)

Why do we need to limit intake of added sugars : Why do we need to limit intake of added sugars :

Cuba

BMI changes during Crisis

Males Females

Gay J, Porrata C, Hernandez M, Clua AM, Arguelles JM, Cabrera A, Silva LC.Institute of Nutrition and Food Hygiene, Havana, Cuba.

Bull Pan Am Health Organ. 1996 Mar;30(1):87-9.

An epidemic neuropathy that broke out in Cuba in late 1991 has exhibited clinical manifestations similar to those of other poly neuropathies of nutritional origin, …

…..a broad range of specific dietary deficiencies, a sugar intake exceeding 15% of total caloric intake, ….and smoking…..

Dietary factors in epidemic neuropathy on the Isle of Youth, Cuba.

Sugars provide empty caloriesSugars provide empty calories

A. Raben et al Am JClin Nutr 2002;76:721–9.

Sugar sweetened drinks lead to unbalanced energy intakeSugar sweetened drinks lead to unbalanced energy intake

sweet drinks lead to increase body weightsweet drinks lead to increase body weight

sweet drinks lead to increase body fatsweet drinks lead to increase body fat

The paraventricular & arcuate nuclei contain neurons capable of stimulating/inhibiting food intake.

Y1R/Y2R denote subtypes of the neuropeptide Y (NPY) rec

MC4R melanocortin 4 rec

PYY peptide YY 3–36,

GHsR GH hormone secretagogue rec

AgRP agouti-related protein,

POMC propio o melanocortin

a-MSH a -melanocyte–stimulating protein LEPR leptin rec, and INSR insulin rec.

Korner J and R Leibel NEJM 349;10 2003

Sugars please Sugars please our brain, our brain,

promote insulin promote insulin secretionsecretion

Velasquez et al Int J of Obesity (2003) 27, 219–226.

Suppression of insulin secretion with drug

HR Subjects HR Subjects responsive responsive to blocking to blocking insulin with insulin with

drugdrug

NR Subjects NR Subjects non non

responsive responsive to blocking to blocking insulin with insulin with

drugdrug

Highly ResponsiveHighly Responsive

Non ResponsiveNon Responsive

Highly ResponsiveHighly Responsive

Non ResponsiveNon Responsive

Lustig et al 2003

Blocking Blocking insulin insulin

secretion secretion decreases decreases

Energy Energy intakeintake

Prentice & Jebb Obesity reviews 187–194 (2003)

Home foodsHome foods Fast foodsFast foods

Sugars increase energy density & elevate intakeSugars increase energy density & elevate intake

Low FatHigh Complex-CHO

Low FatHigh Sugars

Control diet

Low FatHigh Complex-CHO

Low FatHigh Sugars

Control diet

S Poppitt Am J Clin Nutr 2002;75:11–20.

Effect of High Sugar on BMI

Effect of High Sugar on Body Weight

aggravate the metabolic syndromeaggravate the metabolic syndrome

S Poppitt et al Am J Clin Nutr 2002;75:11–20.

Low FatHigh Complex-CHO

Low FatHigh Sugars

Control diet

Control diet

Low FatHigh Sugars

Low FatHigh Complex-CHO

Effect of High Sugar on Total Cholesterol

Effect of High Sugar on Triglycerides

Reduced Glycemic Load

Reduced Fat

Time (months) Time (months)

Ebbeling CB et al Arch Pediatr Adolesc Med. 157: 773-9. 2003

Effects of Glycemic Load on BMI and Body Fat

Change in BMI (kg/m2)

-3

-2

-1

0

1

2

0 6 12

Treatment x time effect: p < 0.05

0 6 12

-5

-4

-3

-2

-1

0

1

2

3

Change in Fat mass (kg)

Treatment x time effect: p < 0.05

Lowering Sugars

reduces body

weight and fat mass

Sugars provides empty calories: this means that depending Sugars provides empty calories: this means that depending on how much sugars you consume you may be getting on how much sugars you consume you may be getting insufficient amounts of vitamins and minerals. insufficient amounts of vitamins and minerals.

Sugars please our brain, promote insulin secretion and Sugars please our brain, promote insulin secretion and especially as sweet drinks lead to unbalanced energy intake especially as sweet drinks lead to unbalanced energy intake

Sugars increase energy density of foods may aggravate the Sugars increase energy density of foods may aggravate the metabolic syndrome in people with the metabolic syndrome metabolic syndrome in people with the metabolic syndrome (visceral obesity, diabetes, heart disease, high BP) (visceral obesity, diabetes, heart disease, high BP)

Why do we need to limit intake of added sugars : Why do we need to limit intake of added sugars :

“promote healthier choices including at least 5 servings of fruits and vegetables a day, reasonable portion sizes, encourage the food industry to provide reasonable food and beverage portion sizes, encourage food outlets to increase the availability of low-calorie, nutritious food items.”In a dietary pattern of any calorie level, if the consumer eats the recommended amounts of vegetables and fruits, grains, low-fat meats and beans, low-fat dairy products, and additional fats,

CDC website http://www.cdc.gov 2004

CHOOSE SENSIBLY . . .

'provide food options that are low in fat, calories and added sugars,

Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.

Choose beverages and foods to moderate your intake of sugars.

http://www.health.gov/dietaryguidelines/dga2000

Nutrition and Your Health:Dietary Guidelines for Americans

         

then the …consumer should have a few calories left over. These extra calories may be filled with added sugars.

Calorie level Added sugars allowance

Added sugars kcal

% sugars kcal of total kcal

1000 20 g* 80 kcal 8%

1200 20 g 80 kcal 6.7%

1400 20 g 80 kcal 5.7%

1600 24 g 96 kcal 6%

1800 32 g 128 kcal 7.1%

2000 40 g 160 kcal 8%

2200 48 g 192 kcal 8.7%

2400 56 g 224 kcal 9.3 %

2600 64 g 256 kcal 9.8 %

2800 72 g 288 kcal 10.2%

3000 80 g 320 kcal 10.6%

3200 112 g 448 kcal 14%

* 1 teaspoon sugar = 4 grams 1 gram sugar = 4 kcal

USDA Food Based Dietary Guidelines

added sugar

s

The USA IOM report’s recommendations regarding added sugars have been widely misinterpreted. I am writing to clarify the intent of the report.

… The report states “A. maximal intake of 25 percent or less of energy from added sugars is suggested. This maximal intake level is based on ensuring sufficient intakes of certain essential micronutrients that are not present in foods and beverages that contain added sugars. A daily intake of added sugars that individuals should aim for to achieve a healthy diet was not set.”

This language is not meant to convey a desirable or even acceptable standard intake. The report states that persons whose intake of added sugars is 25% or more of total calories are more likely to have poorer intakes of important essential nutrients.

It does not address the issue that added sugar intakes at 25% or even well below it, may well have significant implications for caloric balance and weight control. Interpretations suggesting that a sugar intake of 25% of total calories is endorsed by the Institute’s report are incorrect.

It is our intent to clarify the language in the report to address this point before it is published in final text. However, I wish to clarify the report’s findings immediately so that the mischaracterization of the findings is not misleading to the public or to policy-makers.Harvey V. Fineberg, M.D., Ph.D. Sincerely,President Institute of Medicine USA April 15, 2003

The Honorable Tommy G. ThompsonSecretary of Health and Human Services

In the absence of definitive evidence, recommendations must rely on professional judgment. No data suggest that sugar intake per se is advantageous, and some data suggest it may be detrimental.

The studies above, taken in total, indicate that high sugar intake should be avoided. Sugar has no nutritional value other than to provide calories.

To improve the overall nutrient density of the diet and to help reduce the intake of excess calories, individuals should be sure foods high in added sugar are not displacing foods with essential nutrients or increasing calorie intake.

American Heart Association,Circulation.;106:523-527 2002Circulation is available at http://www.circulationaha.

Consultation Process Consultation Process

Memberstates

Memberstates

Civil SocietyCivil

SocietyPrivate sectorPrivate sector

UN agencies

UN agenciesP

has

e II

WHO Strategy on Diet, Physical Activity and HealthWHO Strategy on Diet, Physical Activity and Health

WHA 2004WHA 2004

EB Jan 2004EB Jan 2004SecretariatSecretariatReference

groupReference

group

Ph

ase

III

Preparation of consultation process and finalization of expert report

Preparation of consultation process and finalization of expert report

Ph

ase

I

Modern Humans Behavioral change

is needed