The Future of Food:

What will our plate look like in 2020?

Walter C. Willett, MD, DrPHDepartment of Nutrition

Harvard School of Public Health

June 2015

10-Year Coronary Incidence Per 10,000 Men

Keys, 1980

Incidence

0

1000

2000

3000

0 5 10 15 20 25

% Diet Calories from Saturated Fat

Dalmatia

Velika Krsna

Zrenjanin

BelgradeRome ra

ilroad

MontegiorgioCrevalcore

Corfu

Crete

Slavonia

Zutphen

west Finland

east Finland

Ushibuka

Tanushimaru

y=77+78xr=0.73

9.006

(Keys 1980)

0

10

20

30

40

50

0 40 80 120 160 200 240 280 320

Per Capita Daily Meat Consumption (grams)

Co

lon

Can

cer

Inci

den

ce /

100

,000

Wo

men

(Armstrong & Doll, 1975)

ROM

CHI

COL

YUG

JAM

JAP

NIG

ISRNOR

PRPOL

HUN

FIN

DEN

SWENET FDR

ICEDDR

NZ

USA

CAN

UK

Meat & Colon Cancer Incidence

2.003

Nurses’ Health Study (n=121,700)

Health Professionals Follow-up Study (n=52,000)

Nurses’ Health Study II (n=116,000)

Investigators: Frank Hu, Frank Speizer, Bernie Rosner, Meir Stampfer, Graham Colditz, David Hunter, JoAnn Manson, Sue Hankinson, Eric Rimm, Edward Giovannucci, Alberto Ascherio, Gary Curhan, Charlie Fuchs, Fran Grodstein, Michelle Holmes, Donna Spiegelman

1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2010

DietOcsSmokingWeight/HtMed. Hist.

Diet Diet DietBlood

Diet Diet

1986 1988 1990 1992 1994 1996 1998 2000 2010

Diet Diet DietBlood

Diet

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

Diet Diet Diet

0.198a

Nails

Nails

Blood

100

80

60

40

20

0-20

-40

1%E 2%E 3%E 4%E 5%E

Trans

Sat

Mono

Poly

% C

han

ge in

CH

D

(Hu et al. 1997)

9.131

Nut Consumption and Risk of Coronary Heart Disease (NHS, 1980-1994) (Hu

et al. 1997)

0

0.2

0.4

0.6

0.8

1

AlmostNever

1/week orless

2-4/week 5+/week

Multivariate Relative

Risk

Frequency of Nut Consumption

P, trend = 0.005

••

•

•

9.127

Saturated Fat

Trans Fat

Refined Starch, Sugar

Whole Grains

Unsaturated Vegetable Fats--High monounsaturated vegetable fats--High polyunsaturated vegetable fats

Carbohydrates

29.536

Conclusions1. CHD rates can be dramatically reduced by

nutritional means, but this will not be achieved by replacing saturated fat with carbohydrate.

2. We should abandon recommendations regarding % of energy from fat and avoid pejorative references to fat or “fatty foods”.

3. Advice about dietary fat should focus on replacement of saturated and trans fat with vegetable oil, including sources of N-3 fatty acids.

9.062

Fat & Postmenopausal Breast Cancer in NHS, 1980-2000 (3537 cases)

0

0.5

1

1.5

2

<=2020.1-25

25.1-30

30.1-35

35.1-40

40.1-45

45.1-50

>50

P, trend test 0.11

(Kim et al. 2006)

RR

of

Bre

ast

Ca

nc

er

Cumulative Average Fat Intake (%E)

0.255

0

0.2

0.4

0.6

0.8

1

1.2

Q1 Q2 Q3 Q4 Q5

Premenopausal fiber intake and risk of breast cancer in NHSII (1991-2011)

Mu

ltiv

aria

te R

Rs

Quintiles

(Farvid M et al., preliminary data)

P,trend = 0.002

0.332

Adolescent Red Meat & Risk of Premenopausal Breast Cancer

Q1 Q2 Q3 Q4 Q50

0.5

1

1.5

2

2.5

Quintiles

Mul

tivar

iate

RR

(Farvid MS et al., Int J Cancer 2014)

P,trend = 0.007

0.339

(Dansinger et al. 2005)

29.167

Changes in Food and Beverage Consumption

and Weight Changes Every 4 Years

According to Study Cohort

(Mozaffarian D et al., NEJM 2011)

Food Beverages

23.059

30% fat

33% fat

39% fat

Mean BMI at baseline = 31

Shai et al NEJM 2008

Randomized Dietary Trials of Equal Intensity Intervention

26.101

29.294

Milling of Grains

WholeGrain

RefinedGrain

All parts milled

Endosperm is milled

Germ & Bran

Source: General Mills29.295

Relative Risk of Type 2 Diabetes by Different Levels of Cereal Fiber and Glycemic Load

2.5 2.32.05

2.171.8

1.62

1.511.28

1

0

1

2

3

High Medium Low

High

Medium

LowRelative Risk

>165 165-143 <143

Glycemic Load

>5.8 g/day

2.5 -5.8 g/day

<2.5 g/day

(Salmeron et al,1997)

(ref)

WOMEN

9.038

Cereal Fiber

1.50

1.85

1.061.00

1.39 1.41

1.00 1.11

0.0

0.5

1.0

1.5

2.0

2.5

<1/ mo 1-4/ mo 2-6/ wk >=1/ dSugar-sweetened soft drink consumption

Rel

ativ

e R

isk

multivariate adjusted multivariate + BMI

P<0.001 for trend

Regular Soft Drinks and Type 2 Diabetes, NHS2

(Schulze et al. 2004 JAMA)25.080

0.4

0.6

0.8

1

1.2

1.4

1.6

Reference 1.5 - 5 > 5 - 10 > 10 - 20 > 20-30 > 30

glasses of milk per week

po

ole

d R

R (

95%

CI)

Pooled Analysis of Categories of Milk Intake* & Hip Fractures in Women (All Studies)

*The reference categories in different studies ranged from rarely/never to 1 glass/day

(Bischoff-Ferrari et al.)24.056

Diet and Fatal Prostate Cancer in SDA Men, 1960-1980 (n = 99 cases)

(Snowdon et al, 1984)

Milk

<1 glass/day 1.0

1-2 glasses/day

1.8 (1.0-3.0) 3+

glasses/day 2.4 (1.3-4.3)

p trend = 0.005 3.020

Attributable Risk of Coronary Heart DiseaseDue to Modifiable Diet and Lifestyle Risk

Factors in the NHS (1980 to 1994)

Low Risk: 1. Non smoker 2. BMI < 25 kg/m2

3. Exercise > ½ hr of brisk walking/day 4. Good diet (upper 2 quartiles of score based

on low trans fat, high p/s ratio, low glycemic load, high cereal fiber, high fish, high total folate) 5. Alcohol 5+g/day

• Proportion at low risk = 3.1% • Population Attributable Risk = 82% (95% CI = 58-93%)

Stampfer et al, 20009.092

Percentage of Type 2 Diabetes Potentially Preventable by Simultaneous Reduction of Five

Modifiable Risk Factors (NHS) (Hu et al.)

Low Risk1. Nonsmoking2. BMI < 253. Moderate to vigorous exercise4. Diet score in upper 40% (low trans fat, high cereal fiber, low glycemic load, high P:S ratio)5. Alcohol 5+ grams/day

Percent in low risk group: 4.1%Population attributable risk (PAR): 92% (82-96)

25.026R

29.446

29.443

Multivariate Risks of Cardiovascular Disease & Cancer Among 38,615 Men

1986-1994(McCullough et al. 2002)

0

0.2

0.4

0.6

0.8

1

1.2

1 2 3 4 5

Cardiovascular Disease

Major ChronicDisease

Cancer

Re

lati

ve

Ris

k

Quintiles of Revised Healthy Eating Index

38, 615 MEN

28.016

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

2011-2012

0

10

20

30

40

50

60

AHEI-2010

Alt

erna

te H

ealt

hy E

atin

g In

dex-

2010

Num

ber

of d

eath

s (1

0,00

0 de

aths

)

Change in AHEI through 2012

(Wang DD et al, unpublished data)

29.605a

29.606

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

2011-2012

0

2

4

6

8

10

12

Vegetables FruitWhole grains Sugar-sweetened beverages and fruit juiceNuts and legumes Red and/or processed meattrans Fat Long-chain (ω-3) fats (EPA+DHA)Polyunsaturated fatty acids SodiumAlcohol

Alte

rnat

e H

ealth

y E

atin

g In

dex-

2010

Change in AHEI components through 2012

(Wang DD et al., unpublished)

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-201230

33

36

39

42

45

Low SES Medium SES High SES

Years

Alte

rnat

e H

ealth

y E

atin

g In

dex

- 20

10P for interaction =0.0132

Trends in AHEI -2010 Score by Socioeconomic Status (SES)based on the NHANES

(Wang D et al., unpublished data)

Food Group(Median serv/day)

SNAP Participants

Non-Participants

Whole grains 0.2 0.5

Refined grains 4.4 4.9

Fruit 0.3 0.6

Vegetables 0.7 1.0

Potatoes 0.6 0.5

Eggs 0.1 0.1

Fish/shellfish 0.2 0.2

Nuts/legumes/seeds 0.2 0.4

Red meat 0.5 0.5

Processed meat 0.3 0.3

High-fat dairy products 0.6 0.6

Low-fat dairy products 0 0

Sweets/bakery desserts 0.6 0.9

Salty snacks 0.3 0.3

Regular sodas 1.6 1.3

All SSBs 2.3 1.9

Leung C., et al., Am J Clin Nutr 2012

Dietary Intake and Dietary Qualityof Low-Income Adults

Domestic utilization of grain from FAO 2009: includes wheat, rice, barley, maize, rye, oats,

millet, sorghum, and other cereals.

29.

https://www.soylent.com/ https://www.soylent.com/      https://www.soylent.com/

21.096

New England Strategic Plan forWeight Control (NECON 2004)

Schools Health Care Providers Work Sites Media Physical Environment Food Environment Data for Action Economic Analysis

29.075

www.neconinfo.org