Food for thought: How functional

ingredients can help tackle (age-related) cardiometabolic disorders

Sumanto Haldar

Clinical Nutrition Research Centre, Singapore

Presentation Overview

• Prevalence of ageing and the associated increase in

cardiometabolic disease risk in Asia

• Foods and Food Components believed to contribute to

or alleviate risk of cardiometabolic diseases

• Some recent research at the Clinical Nutrition Research

Centre (CNRC) Singapore

World population aged > 60 years

World Population Ageing 2013, United Nations

World population pyramids

Harper S, Science (2014) 346: 587-591

Years lived with disability 1990-2016

Years lived with

disability has not

improved since the

1990s despite

improvements in life

expectancy

Lancet (2017) 390:

1211-1259

Age associated chronic “disorders”

• Obesity

• Diabetes

• Heart disease

• Cancer

• Cognitive decline

• Poor mobility

Epidemic of obesity in Singapore

HPB-MOH Clinical Practice

Guidelines 1/2016

Moderate-risk – 23-27.4 kg/m2

High-risk – ≥ 27.5 kg/m2

> 50% Singaporeans

have a moderate to high

risk BMI

Age-related increase in obesity

• Despite reductions in

energy intake and/appetite

with increasing age

• Lower total energy

expenditure (TEE)

Phys Rev 2006 86: 661-667

BMC Public Health 2012 12: 658

Asians have different body fat composition and

distribution

Adv Food Nutr Res 2015, 75: 97-154

Type 2 diabetes occurs at a lower BMI in

Asians

RCW Ma et al, Ann N Y Acad Sci (2013); 128: 64-91

Study in Asian adolescents

Elsamadony A et al, Obesity (2017), 25: 1974-1979

427 Asian and 306 non-

Asian 14-19 years old

Asians had:

- WC, BMI

- TG

Asians had higher

insulin resitance for a

given excess weight

WC change between 1990s and 2010s at BMI 25 Kg/m2

Albrecht SS et al, Eur J Clin Nutr (2015), 69: 1312

So simply fixing energy imbalance will

NOT solve the problem

• While short-term weight loss can be achieved

through calorie restriction, the biological relevance

may be limited

• Obesity and associated cardiometabolic

diseases have a multifactorial and multicomponent

aetiology (beyond energy balance)

– 1 nutrient 1 disease or condition

Dietary pattern vs single nutrients

Zheng Y et al, Nat. Rev. Endo. 2018; 14: 88-98

Mozaffarian D, Circulation 2016; 133: 187-225

Calorie content of two meals

1575 kcal 1575 kcalProf. Barbara Rolls, Pennsylvania State University

Dietary energy density and obesity

Higher the dietary

energy density (kcal/g)

the greater the

propensity for adiposity

Eur J Nutr (2015) 54:

59-65

Refined grain intake and metabolic

syndrome risk – CURES study

> 2000 individuals

Higher refined grain

intake associated with:

- WC

- BP

- FBG

- TG, LDL-C

- HOMA-IR

Metab Clin Exp (2009)

58: 675-681

Adding legumes to rice decreases its GR

Crossover RCT in T2D

patients (n=17, 35-70 yrs)

Served 50 g available CHO

Rice +/- legumes

- in PPG from 90 min

onwards with all bean

types

Nut J (2012) 11: 23

Non-soy legumes and lipid profile

Meta-analysis of 10 RCTs ≥ 3

wks duration (n=268)

- Total Cholesterol

- LDL-Cholesterol

- TG (marginal p)

Nut Metab Cardiov Dis (2011)

21: 94-103

Carob extract juice vs sucrose beverage

HbA1C

Mean glucose

after main

meals

Fasting

glucose

Oxidative

stress in PBLs

12 week double-blind RCTs in 38 T2Ds

Focus needs to be on ‘beneficial’ dietary

pattern based on improved food quality• Reduce

– Rapidly digested, (refined) carbohydrates

– Processed meats

– Sodium and trans fat

– Added sugar

• Increase

– Fruits and non-starchy vegetables

– Legumes and nuts

– Whole grains

– Fish

• Choose foods that are less calorie dense but more nutrient

dense

Foods and dietary patterns more relevant

than single nutrients

• Importance of food based guidelines – individual relates to foods

better than nutrients

• More effective to make concerted but small changes in several

dietary factors rather than a big change in one factor

• Consideration needs to be made on food matrix, food processing

and food preparation

• “Diet quality independent of energy imbalance can influence

metabolic risk and propensity towards abdominal adiposity”

- Mozaffarian D, Circulation 2016; 133: 187-225

Clinical Nutrition Research Centre

(CNRC)

Our Vision:To develop an integrated program that understands how

food, food components and processing may be used to

minimize risk of obesity, diabetes, CVD and promote

healthy aging, within the Asian dietary context, in Asians

https://www.a-star.edu.sg/cnrc

CNRC Facilities

Facilities

CALORIMETERS

SPECIALIZED LABORATORIES

& EQUIPMENT

OTHER MONITORING

CAPABILITIES

BODY COMPOSITION

• Blood Biochemistry and

Analytical Labs

• Food Chemistry Analysis

Labs

• In vitro Digestion System

• Product Development

Kitchen

• Sensory Analysis Booths

• Computer-based Cognitive

Testing Booths

• Treadmill and Ergometer

Room

• Clinical Suites

• Continuous Glucose Monitoring

Systems (CGMS)

• Hyperinsulinemic Euglycemic

Clamp

• Ambulatory Blood Pressure

Monitoring (ABPM)

• Peripheral artery tonometry

(EndoPAT)

• Electromyography Measurements

• Muscle Biopsy

• Infra-red (IR) Camera Imaging

• Micro Oxygen Sensors

• Whole-body

Calorimeters

• Indirect Calorimeter

(Basal Metabolic Rate

measurement)

• COSMED BodPod® and

PeaPod® Scanning

(Air Displacement

Plethysmography)

• Dual-energy X-ray

Absorptiometry (DEXA)

Scanning

Ambulatory

blood pressure

monitoring

Triaxial

accelerometer

EndoPAT

Continuous

Glucose Monitor

Sucrose (Table sugar) Isomaltulose

α1, 2-glycosidic bondGlycemic Index: 65Energy: 4 kcal/gFood source: Sugar cane

α1, 6-glycosidic bondGlycemic Index: 32Energy: 4 kcal/gFood source: Honey

65 32

Effect of inclusion of isomaltulose in beverages along with

low-GI meals on 24h GR in Chinese males

-0.5

0.0

0.5

1.0

1.5

2.0

2.50

60

12

0

18

0

24

0

30

0

36

0

42

0

48

0

54

0

60

0

66

0

72

0

78

0

84

0

90

0

96

0

10

20

10

80

11

40

12

00

12

60

13

20

13

80

14

4024

h in

crem

enta

l ch

ange

in g

luco

se

(mm

ol/

L)

time (min)

low GI high GI

10h inside whole body calorimeter

Dinner

Breakfast

Lunch

Snack

Inclusion Isomaltulose or sucrose

during the test meals:

30g with dinner in fruit drink

30g with breakfast added to tea

20g with lunch in fruit drink

20g with snack added to tean = 20

age: 21-29

BMI:18-29

Henry CJ et al. Nutrients. 2017 ; 9(5): E473.

Beta-glucan

OatsBarley

• Soluble fiber obtained from:

Barley and oats

• EFSA approved ingredient

• 4 g/30 g dry weight portion

Food applications:

Yellow noodles Beta-glucan powder

Beta-glucan yellow noodles

Glycemic response and glycemic index of various noodles

-1.0

1.0

3.0

5.0

0 15 30 45 60 75 90 105 120Ch

an

ge in

b

loo

d g

luc

os

e

(mm

ol/L

)

Time (mins)

Glucose reference

Noodles

Beta-glucan noodles

Addition of plant protein isolates in sugar

sweetened milkshake

Beverage Energy

(kJ)

Available

Carbohydrate

(g)

Protein

(g)

Fat

(g)

Fibre

(g)

Weight

(g)

Control 1252 50 3 10 4 400

Oats 1672 50 27 10 5 400

Pea 1680 50 27 10 4 400

Rice 1672 50 27 10 5 400

Ingredients:

• Water

• Sucrose

• Hershey chocolate powder

• Thick cream

• Protein powder (to ↑ 24g protein)

Effect of addition of plant protein isolates on

glucose homeostasis

Tan SY et al. Eur. J. Nutr. 2017 DOI 10.1007/s00394-017-1547-3

Dietary bioactives as functional foods to improve

cardiometabolic health

Polyphenol intake and CMD risk

PolySPice (PSP) Study

• Whether consuming polyphenol rich mixed spices and base vegetables used as curry ingredients can improve postprandial glucose control in healthy volunteers?

• Specific outcome measures included: – Total polyphenol content (TPC) and urinary polyphenol excretion

– 24 h glucose (using CGM) and postprandial insulin, TG responses

– Gut hormone (e.g., GLP-1, ghrelin) and subjective appetite responses

Total Polyphenol Content (TPC) of test meals using

Folin-Ciocalteu assay

D0C – Dose 0 Control (0 g spices)

D1C – Dose 1 Curry (6 g spices)

D2C – Dose 2 Curry (12 g spices)

Values represent mean ± SD (n=6).

****P ≤ 0.0001

Haldar et al Eur J Nutr 2017

Mean incremental Glucose concentration

p for linear trend < 0.05

Haldar et al Eur J Nutr 2017

Postprandial GLP-1 and Insulin concentrations

As compared with D0C

Mean iAUCPB D1C = -6%

Mean iAUCPB D2C = -15%

p for trend = 0.089

As compared with D0C

Mean iAUCPB D1C = +28%

Mean iAUCPB D2C = +45%

p for linear trend <0.05

Haldar et al Eur J Nutr 2017

Haldar et al Eur J Clin Nutr 2018; 72: 297-300

Cocoa flavanol and CVD risk

Adding mangosteen pericarp waste to enhance

functional properties of dark chocolate

• Increase in total polyphenol contents (TPC) of both

regular and compound chocolates

• Without compromising sensory aspects

Phytochemical Rich Ingredients as Functional

Foods (PRIFF) Study

300,000 known

plant species100,000 used by

humankind

30000

Edible

7000 used as food

at local level120 Important at national

scale

30 provide 90% of plant

calories

3 provide

60% calories

(rice wheat

maize)

Need to better explore biodiversity to alleviate the risk of

age-associated chronic diseases?

Summary

• Ageing is associated with metabolic dysfunction

• Healthy metabolism is more than just calorie balance

• Functional ingredients can play important roles in reducing obesity and

age associated cardiometabolic disease risk

• Adherence to dietary patterns that are more nutrient dense (e.g.,

phytochemical rich) rather than energy dense should be encouraged

• Given the biodiversity of edible plants and plant products within Asia, the

opportunity to intervene to favorably modulate CMD risk is promising!

CNRC Team

Thank you!

https://www.a-star.edu.sg/cnrc

sumanto_haldar@sics.a-star.edu.sg

“I am grateful to old age because it has

increased my desire for good

conversation and decreased my desire

for good food.”

—Cicero, DeSenectute, 43 B.C.

“I am grateful to old age because it has

increased my desire for good

conversation AND INCREASED my

desire for good food in order to

enhance healthy ageing”

—Unknown, 2018 A.D.