Transcript Palaeolithic diet What is it?

Eating healthily
– changes needed
Dr Rosemary Stanton OAM
influences on food choices
- availability
- cost
- cultural influences
- convenience
- marketing
- ethical considerations
...
- nutrition & health
© Rosemary Stanton 2013
why dietary guidelines?
 1960s – 600-800 foods available
 now - >30,000 foods in supermarket
  diet-related health problems
(obesity, type 2 diabetes, cancers,
cardiovascular disease, osteoporosis)
 costs to individuals
 costs to governments
© Rosemary Stanton 2013
Australian ‘history’
1979
1981
1991
2003
2013
Dietary Goals
Dietary Guidelines
1st revision
2nd revision
3rd revision
© Rosemary Stanton 2013
dietary guidelines
changes from first guidelines
 increase in breast feeding
  refined sugar (led to a campaign
‘sugar – a natural part of life’)
  meat consumption (led to a campaign
titled ‘feed the man meat’)
 fat-reduced milk became popular
© Rosemary Stanton 2013
dietary guidelines
effective ?
Melbourne study, 10,561 women, aged 50-55
one in three followed some guidelines
only 2 followed all guidelines
Ball K, Mishra GD, Thane CW, Hodge A. How well do Australian women comply with
dietary guidelines? Pub Health Nutr 2004; 7: 443-452.
© Rosemary Stanton 2013
key question for guidelines
what should
Australians eat?
© Rosemary Stanton 2013
2013 dietary guidelines
changed focus
– foods, food groups & dietary patterns
– not food components or individual
nutrients
© Rosemary Stanton 2013
dietary guidelines
aim of the revision
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‘aspirational’
realistic, practical & flexible
evolutionary (incremental, not radical)
based on best available scientific
evidence for food, diet, health
relationships
© Rosemary Stanton 2013
dietary guidelines
other aims (wanted by some)
– include a guideline on environmental
aspects of food choices
– give social equity more priority
- avoid fortified & functional foods
© Rosemary Stanton 2013
approach changed
– commissioned systematic literature review
– developed set of targeted questions to answer
question ‘what should Australians eat?’
– prioritised questions focussing on new or emerging
issues since 2003 (did not re-examine established relationships)
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evidence report (1100 pages, >55,000 papers)
process manual (evidence statements if >5 studies)
harmonisation assisted by a methodologist
results informed revision of core food group
modelling & dietary guidelines
© Rosemary Stanton 2013
evidence informing the
revised draft dietary guidelines
dietary intakes from
national surveys
authoritative reports &
additional literature
NRVs for Australia and New
Zealand incl RDIs (2005)
food modelling system to
inform the AGTHE (2010)
draft evidence report
to inform the review of the
Australian Dietary Guidelines
Draft (2012),
Australian Dietary
Guidelines (2013)
draft AGTHE (2011)
Dietary Guidelines for all
Australians (2003)
© Rosemary Stanton 2013
draft literature review
pregnancy & breastfeeding
(2011)
what has changed - format
– all age & gender groups in one
concise document
– infant feeding guidelines for health
workers as a separate document
© Rosemary Stanton 2013
what has changed - format
standardised structure:
 context of the food/group in Australian diet
 supporting evidence including:
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graded evidence statements (Evidence Report)
other evidence (established relationships - previous DGs)
comparison with other authoritative international reports
(brief) plausibility/mechanisms
 practical considerations
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additional information (infants, children, pregnancy,
breastfeeding, Aboriginal & Torres Strait Islanders)
© Rosemary Stanton 2013
what has changed - content
evidence base supports
 focus on total energy intake/balance & energydensity rather than specific macronutrients
 less emphasis on decreasing total fat, but focus on
limiting foods high in sat/trans fat + moderate
consumption of foods rich in unsaturated fats
 guidance for population-based weight loss (for
those without other health problems)
 more emphasis on dietary patterns across the life
stages, supporting family-focused eating patterns
© Rosemary Stanton 2013
changes in evidence
 strengthened for health benefits of
- breastfeeding (benefits later in life)
- milk (cardiovascular & some cancers)
- fruit (cardiovascular)
- non-starchy vegetables (some cancers)
- wholegrains (cardiovascular & weight)
 strengthened for health risks of
- sugar-sweetened beverages & weight gain
in children & adults
© Rosemary Stanton 2013
recommendations
1. to achieve & maintain a healthy
weight, be physically active & choose
amounts of nutritious foods & drinks
to meet energy needs
© Rosemary Stanton 2013
recommendations
2. enjoy a wide variety of nutritious foods from
these five groups every day
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plenty of vegetables, different types & colours, &
legumes/beans
fruit
grain (cereal) foods, mostly wholegrain &/or high cereal fibre
varieties, such as breads, cereals, rice, pasta, noodles, polenta,
couscous, oats, quinoa, barley
lean meat & poultry, fish, eggs, tofu, nuts, seeds &
legumes/beans
milk, yoghurt, cheese or alternatives, mostly reduced fat (not
for under 2s)
and drink water
© Rosemary Stanton 2013
recommendations
3. limit intake of foods containing
saturated fat, added salt, added
sugars & alcohol
© Rosemary Stanton 2013
recommendations
a. limit intake of foods containing saturated fat
such as many biscuits, cakes, pastries, pies, processed
meats, commercial burgers, pizza, fried foods, potato
chips & crisps & other savoury snacks
- replace high fat foods that contain predominantly saturated
fats such as butter, cream, cooking margarine, coconut & palm
oil with foods that contain predominantly polyunsaturated &
monounsaturated fats such as oils, spreads, nut
butters/pastes & avocado.
- low fat diets are not suitable for children under the age of 2
years.
© Rosemary Stanton 2013
recommendations
b. limit intake of foods containing added salt
- read food labels to choose lower sodium
options among similar foods
- do not add salt to foods in cooking or at the
table
© Rosemary Stanton 2013
recommendations
c. limit intake of foods & drinks containing
added sugars such as:
- confectionary
- sugar-sweetened soft drinks & cordials
- fruit drinks
- vitamin waters
- energy & sports drinks
© Rosemary Stanton 2013
recommendations
d. if you choose to drink alcohol, limit intake.
for women who are pregnant, planning a
pregnancy or breastfeeding, not drinking
alcohol is the safest option
© Rosemary Stanton 2013
recommendations
4. encourage, support & promote
breastfeeding
© Rosemary Stanton 2013
recommendations
5. care for your food; prepare &
store it carefully
© Rosemary Stanton 2013
what has changed
food modelling system & AGTHE
– ages 6 mths to 70 + (previously 2 years and over)
- reflects the food supply & consumption patterns
- reduced serve size for bread (40g) cf 1994 (60g)
- wholegrain: refined grains = 2:1
- plant-based options given greater prominence
- greater flexibility
- limited scope for smallest, least active people to
choose any ‘extras’
© Rosemary Stanton 2013
what needs to change
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vegetables , but  chips
fruit , but limit juice
nuts/seeds 
wholegrains , refined grains 
fish 
red meat for men 
reduced-fat milk 
© Rosemary Stanton 2013
what needs to change
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sugary drinks 
junk foods 
alcohol 
discretionary foods  from 35-40%
energy to 10% energy (or zero)
Rangan AM, Randall D, Hector DJ, Gill TP, Webb KL. Consumption of ‘extra’ foods by Australian children:
types, quantities and contribution to energy and nutrient intake. Eur J Clin Nutr 2008; 62(3):356-64
Rangan AM, Schindeler S, Hector DJ, , Gill TP, Webb KL. Consumption of ‘extra’ foods by Australian
adults: types, quantities and contribution to energy and nutrient intake. Eur J Clin Nutr 2009; 63:865-71
© Rosemary Stanton 2013
 graph represents
proportions for
each group
 accompanying
tables explain
serves (& serve
sizes) for each
age group
 educator’s guide
includes rationale
© Rosemary Stanton 2013
 consumer
materials with
messages and
practical tips
common questions
 why isn’t there a guideline on
sustainable food choices ?
 fats – why not a separate fat group ?
 GI – why is it not included ?
 ‘extras’ – why don’t they get a place
on the plate ?
© Rosemary Stanton 2013
what needs to change
 no industry influence at policy level
(their aim is to sell products; ours is to set
guidelines, do the teaching)
 accept that we need ‘less’
 accept that discretionary foods don’t
fit every diet
 accept that we must incorporate
sustainable food futures
© Rosemary Stanton 2013
challenges
environmental /sustainability
 rapidly emerging evidence base
 type of evidence differs from
food/health relationships
 differences between & within countries
 politically sensitive issue
© Rosemary Stanton 2013
key messages
 discretionary foods – no need & not much
room for them
 dietary patterns promoted by the DGs are
good for health, more sustainable,
practical, realistic & socially equitable
 dietary guidelines are the reference for
nutrition policies
 details at www.eatforhealth.gov.au
© Rosemary Stanton 2013
what we eat
health
social equity
protection of
land & water
© Rosemary Stanton 2013