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