DIET AND LIFESTYLE

S. A. Udipi

Professor & Head

Dept. of Food Science and Nutrition,

S.N.D.T. Women’s University

Food and Man

• Food occupies a central position in life.

- beyond appeasement of hunger.

- part of our value systems.

- symbol of hospitality, pleasure, love,

security.

- symbolize status and power.

- emotional connotations.

Indian modern society – a paradox

• One end of the spectrum – a scene of plenty , at the other end, food and nutritional security are unfulfilled dreams

• Nutrition a critical component of risk reduction and treatment

• India faces double burden of malnutrition

• Undernutrition in pregnancy – increased risk of NCDs?

Globalization Diet and Lifestyle

Global markets Global trading system

Cultural globalization

Migration

Cross-cultural interaction Increasing world trade

Increasing array of

manufactured goods

Widespread flow of information, ideas, lifestyles Product marketingAdvertising

Changing dietary and life style patterns

Nutrition Transition

Globalization

• Nutrition transition towards diets with high proportions of salt, saturated fats, sugar

• Availability and use of drugs

• Consumption of alcohol and tobacco products

• Results in profound , complex changes in nature of society

• Brings new opportunities and risks

Frequency of Consumption of Foodstuffs by Call Center Employees (n=1400)

Food items Daily 2-3 x /week 1x/week 1 x/fortnight

Fried snacks 24.0 27.1 22.0 7.7

Pizza/burger 3.8 12.7 28.0 14.6

Icecream 6.6 9.1 27.6 13.7

Chocolate 20.5 18.5 16.4 12.6

Mithai 6.9 10.9 16.7 11.6

Biscuits 32.4 18.7 15.2 10.8

Wafers/chips 26.9 20.6 17.0 12.8

Soft drinks 25.4 20.4 19.4 9.6

Juices 25.4 21.3 15.7 13.4

Alchohol/Beer 3.1 4.5 9.6 8.4

Leafy vegetables 29.3 31.4 19.5 9.4

Fruits 41.7 24.3 16.1 8.8

Non vegetarian foods 19.9 20.9 15.3 6.5

Consequences of Job on Eating Patterns

• Overeating - 35%• Eat less than usual - 35.2%• Irregular meal timings - 61.1%• Skipping meals - 56.9%• Eat out more - 61.8%• Consume fried foods - 50.0%• Consume tea/coffee - 53.5%• Consume soft drinks - 40.1%

Percent Infants consuming various energy dense foods

Foodstuff %Infants

Chocolates 56.7

Marie biscuit 48.8

Glucose biscuit 47.0

Wafers/chips 43.9

Icecream 39.6

Cakes and pastries 33.5

Milk shakes 19.5

Soft drinks 16.5

Pizza 14.0

Imported fruit purees 12.8

Noodles 11.0

French fries 9.1

Pasta 8.5

Burger 7.3

Imported vegetable puree 7.3

Number of Feeds / week given to Infants

Foods Underweight(n=2)

Normal weight (n=83)

Overweight(n=33)

Obese( n=46)

Cereals 16.5 ± 0.4 19.2± 0.5 20.5± 0.6 22.1 ± 0.6

Halwa 0.0 2.0 ± 0.6 3.5 ± 0.4 4.6 ± 0.8

Vegetables 0.0 8.8± 0.5 8.4 ± 0.5 9.7 ± 0.6

Potato/sweet potato 7.0±0.0 5.3±0.3 6.2±0.2 7.3±0.3

Fruits 10.5±0.5 10.4±0.4 11.7±0.5 11.6±0.4

Fruit juices 0.0 5.3±0.2 4.5±0.3 9.7±0.5

Animal milk/Infant formula

14.0±1.0 20.0±0.9 24.0±1.1 26.8±0.9

Paneer and Cheese 0.0 4.9±0.3 6.6±0.4 9.0±0.5

Non-vegetarian foods 4.5±0.4 10.8±2.8 12.1±0.9 12.4±0.8

Energy dense foods 3.0±0.0 8.4±0.4 9.9±0.5 12.0±0.7

Biscuits 7.0±0.0 8.1±0.4 8.5±0.4 10.5±0.3

Diet Patterns of 2-5 yr old children

• 41-53% children offered food as a reward• Foods offered – chocolates, pizzas, burgers• 48-50% children watch television while eating ,

4-6% study while eating• 50-57% children 3-5 yrs of age eat out• (1-3 x / week)• Fast foods, carbonated drinks, milk shakes, ice

cream, fruit juice, other sweetened beverage

Frequency of Consumption of various Foods

Items Daily 1-2 x /week

Pulav/Biryani 4.3 31.7

Cheese 11.3 40.2

Paneer 2.7 43.3

Potato, yam 20.6 47.5

Banana, chickoo, custard apple 35.8 45.3

Carbonated beverages 2.4 16.1

Chips, wafers, farsan 11.4 11.8

Fruit based beverages 2.9 22.2

Pastries, cakes 4.8 24.2

Chocolates 18.6 46.7

Instant noodles 4.4 44.4

Diet, Obesity, Diabetes and CVD

• Carbohydrate ,glycemic load

• Dietary fat and fatty acids

• Fibre

• Sodium

• Western style vs Mediterranean, Paleolithic diets

Glycemic Index, Glycemic LoadHigher glycemic load( incl. intake of starches with high GL)

glucose response

Serum Insulin levels

Urinary C- peptide

Glycated Hb

Blood pressure

Impaired fibrinolysis, thrombosis

hs- CRP( independent of BMI, total

energy intake, other risk factors)

Mediterranean diets and Health• Meta- analysis –mortality evaluated

Total mortality 8 cohorts, 9 studies

514816 subjects, 33576 deaths

Cardiovascular mortality

3 cohorts, 4 studies

404491 subjects, 3876 fatal events

Cancer incidence/mortality

5 cohorts, 6 studies

521366 subjects, 10929 events

Parkinson’s ,

Alzheimer’s

2 cohorts, 3 studies

133626 subjects, 783 cases

Outcomes

• A 2-point increase in score significantly assoc with reduced risk of mortality from any cause

• Greater adherence risk of mortality from cardiovascular disease, neoplasm,

reduced incidence of Parkinson’s,

Alzheimer’s

Sofi et al. (2008) 337:1344-1351

Paleolithic diets - benefits

• In Type 2 diabetics(comparison with Diabetic diet for 3 months)

- improved glycemic control, - lower HbA1c levels, - decline in insulin levels, - lower TAG levels( abdominal fat?) - lower body weight, WC, diastolic BP -

Jonsson et al. (2009) Cardiovasc Diabetol 8:35-49

School age children, physical activity & sleep

Negative correlation between :

• Total number of hours children sleep and BMI.

• Duration of walking and BMI, mode of transport to reach school.

• Total time spent in play and BMI.

• Attending tuition classes and BMI.

Physical activity

• Intensity (degree / extent of exertion -- % of heart rate or lung volume VO2

• Duration ( length of time)

• Frequency ( # of times a given activity is performed)

Benefits of Exercise

• More effective fibrinolytic profile*• Plasma fibrinogen (75% VO2 max for 30

mins)*• Risk of thrombus formation*• Long term exercise regimen (60% VO2 max,

30 mins)**• Platelet adhesiveness, aggregability• Tissue plasminogen activator, Plasminogen

activator inhibitor-1*El Sayed et al (1999) Thromb Res; 96:467-472.

** Wang et al (1995) Arterioscler Thromb Vasc Biol; 15:1668-1674.

Postmenopausal sedentary women

Plasminogen activator Inhibitor (AU/mL)

Tissue Plasminogen activator (U/mL)

Sedentary 14.5 ± 1.2 1.3 ± 0.1

Physically active 6.5 ± 1.1 2.7 ± 0.4

Source: DeSouza et al (1998) Arterioscler Thromb Vasc Biol. 18:362-68

Physical Activity& Blood Coagulation

Exercise and Blood Pressure

Rowland (2001) routine daily exercise thro’out life time

systolic and diastolic in hypertensives & normotensives ( Adults n=1076)

Izqueiredo-Porrera et al (2000) exercise rehabilitation 6 mos, 3 x

Decrease in systolic BP, no change in diastolic ( older adults 54-84 yrs n=48)

Jakes et al (2003) Increased time of TV viewing– increase in BP

Increased level of vigorous activity – lower diastolic BP ( middle age & older adults

45-74 yrs, n= 15,515).

Physical Activity & Vascular remodelling

• Angiogenesis – growth of new capillaries from existing ones – increases perfusion in cardiovascular tissues & cells, reduces effects of ischemia.

• Vasculogenesis – formation of new blood vessels in original position and growth of endothelial progenitor cells (EPCs).

• Arteriogenesis – modification of pre-existing arterioles, affecting size, length & diameter of arterioles

Exercise and Vascular Remodelling

Group Lumen diameter of femoral artery (mm)

Arterial wall (intima-media) thickness (mm)

Endurance trained 9.62 ± 0.12 4.6 ± 0.1

Sedentary 9.03 ± 0.13 4.7 ± 0.10

Dinenno et al (2001) J Physiol. 534:287-95.

Benefits of Exercise contd

• Miyachi et al (1998) -- Endurance training – arteriogenesis increased CSA (16%) of ascending aorta

24% CSA of abdominal aorta, 20% increase in blood flow

Kleim et al (2002) -- Angiogenesis in rats Increased blood vessel density in caudal

forelimb muscle facilitated better oxygen transport Decreased diffusion time Improved glucose uptake

Laufs et al (2004) -- Elevated a subset of bone marrow derived EPCs enhanced angiogenesis

We may / may not consume more energy per se

BUT

The composition of what we eat is markedly different compared to the assumed hunter, gatherers on which human appetites and metabolism, physiology evolved

• Comparison of ED of diets: African diets - 450kJ/100g Average British Diet – 670kJ/100g Av. Fast food outlet -- 1100 kJ/100g

• More sedentary lifestyles

Gardner and Rhodes (2009) Adv Exp Med Biol; 646:83-93.

You are what you eat