Transcript Priority health issues.

Priority health issues
Georgine Leung
Nutrition Scientist
British Nutrition Foundation
© Food – a fact of life 2011
Priority health issues
• Diabetes mellitus
• Nutrition, health and
schoolchildren
- Major nutrition issues
- School food provision
• Energy balance
© Food – a fact of life 2011
Diabetes mellitus
Diabetes is the major cause of premature illness and
death in most countries.
There are two main types: Type 1 and Type 2.
Currently, there are 2.8 million people diagnosed with
diabetes in the UK and an estimated 850,000 people
who have the condition but don’t know it (Diabetes
UK 2011).
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Diabetes mellitus
This is a condition where the amount of blood glucose
is too high because the body cannot use it properly.
The pancreas does not produce any insulin or not
enough – or the insulin that is produced does not work
properly (known as insulin resistance).
This can result in raised blood glucose, known as
hyperglycaemia, which can adversely affect brain
function. Cells are not able to take up glucose and
use it as a fuel, resulting in fatigue and weight loss.
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Type 1 diabetes
This is also known as insulin-dependent diabetes and is
an auto-immune condition in which the immune
system of the body turns against itself.
This disease causes permanent damage to particular
cells in the pancreas that produce insulin.
Possible causes include viral or other infection, with a
genetic predisposition.
This can be managed by injections of insulin with a
healthy diet.
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Risk factors
• Family history.
• Ethnicity.
• Overweight or obese (especially central obesity).
• Impaired glucose tolerance or fasting glycaemia.
• High blood pressure and history with heart attack or
stroke.
• History of gestational diabetes.
• Severe mental health problems.
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Type 2 diabetes
This is also known as non-insulin dependent diabetes
and occurs when the body does not produce enough
insulin or the insulin produced does not work properly
(insulin resistance).
Usually develops in middle-aged people and in later
life, but has been seen in younger adults (particularly
South Asian and African-Caribbean people) and also
recently amongst overweight teenagers in the UK.
Can often be prevented and reversed in the early
stages through changes in health behaviours.
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Some myth-busting…
Despite popular belief, there is no
evidence to suggest that a high
consumption of sugars causes diabetes.
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Carbohydrate and diabetes
Large intakes should be avoided, but they do not
need to be omitted from the diet.
The diet recommended for individuals with diabetes
should be high in complex carbohydrates and low in
fat, similar to the rest of the population.
Individuals who take insulin to control their diabetes
need to eat adequate amounts of carbohydrate
foods at regular intervals to help them control their
blood glucose levels.
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Glycaemic index (GI)
GI is a ranking of foods to measure how quickly
glucose is released into the bloodstream after eating.
Low GI foods break down slowly during digestion and
release glucose slowly into the blood.
Glucose or white bread is used as the standard
reference (GI 100), and other foods are measured
against this.
© Food – a fact of life 2011
Glycaemic index (GI)
Addition of fat and protein slows down the process at
which carbohydrate is absorbed and lower the GI. If
people confine themselves to low GI foods only, their
diet may become unbalanced.
Also affected by the cooking method, processing, the
ripeness of a fruit, the variety of a vegetable, the
structure and texture of a carbohydrate etc.
The GI of a food only informs how quickly or slowly it
raises the blood glucose when the food is eaten on its
own, but foods are usually eaten as part of a meal.
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Glycaemic index (GI): examples
Low GI
Medium GI
High GI
Apples, oranges, pears
and peaches
Honey and jam
Glucose
Beans and pulses
Shredded wheat
White and wholemeal
bread
Pasta
Ice-cream
Brown rice, cooked
Sweet potato, peeled
and boiled
New potatoes, peeled
and boiled
White rice, cooked
Sweet corn
White basmati rice,
cooked
Cornflakes
Porridge
Pitta bread
Baked potato
Custard
Cous cous
Mashed potato
Noodles
All bran cereals
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(Diabetes UK)
Eating well with diabetes
1. Eat three meals a day.
2. Include starchy foods at every meal.
3. Cut down on fat, especially saturated fat.
4. Eat more fruit and vegetables.
5. Include more beans and pulses.
6. Aim for at least two portions of oily fish a week.
7. Limit foods high in sugar.
8. Reduce salt in the diet.
9. Drink alcohol in moderation only.
10.Don’t use diabetic food or drink.
(Diabetes UK 2010)
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Nutrition, health and school children
Micronutrient levels in school children
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Some regional differences in Scotland
Boys in Scotland were less likely to have eaten all
types of fish (including oily fish) than children
elsewhere.
Boys and girls in Scotland were also less likely to have
consumed many types of vegetables than children in
other regions (lower vitamin C status)
Chocolate confectionery was also more likely to be
consumed in boys in Scotland compared with London
and the South East (94% compared with 82%).
(Gregory et al. 2000)
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Iron-deficiency anaemia
Globally, 50% of anaemia cases are linked to low iron
intakes, which is common amongst UK girls of 11 to 18
years (46% reported levels below the LRNI).
Around 90% of dietary iron is available in non-haem
form, which is influenced by the presence of other
components such as vitamin C and phytates.
Anaemia is common in girls who had tried to lose
weight over the past year and amongst vegetarians.
Symptoms include fatigue and poor cognition in
children (also linked to socioeconomic and biomedical
disadvantages).
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Bone health
Most of the skeletal mass is laid down during childhood
and adolescence (80-90% peak bone mass). Nutrition
and physical activity play an important role in bone
development.
• Calcium – 99% stored in bone and teeth.
• Vitamin D – helps absorb calcium.
• High-impact weight-bearing physical activities.
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School food provision
• School food standards
• Scotland’s free fruit and veg scheme
• Free school meals
• Packed lunches
• Breakfast clubs
Plus… Food in the curriculum!
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Summary of food standards for
school lunches in Scotland
Fruit and vegetables
A choice of at least two types of vegetables and two types of fruit (not
including fruit juice) must be provided every day as part of the school
lunch.
Oily fish
Oily fish must be provided at least once every three weeks.
Variety of extra bread
Additional bread must be provided every day as a meal accompaniment,
with a variety of bread, which must include brown or wholemeal, being
provided over the week.
Oils and spreads
Only oils and spreads high in polyunsaturated and/or monounsaturated
fatty acids can be used in food preparation.
Deep-fried foods
Menus must not contain more than three deep-fried items in a single
week.
Table salt and other
condiments
Additional salt cannot be provided.
Condiments must be dispensed in no more than 10ml portions
Confectionery
No confectionery can be provided
Savoury snacks
No savoury snacks can be provided except savoury crackers, oatcakes or
breadsticks.
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(The Scottish government 2008)
Summary of nutrient standards for
school lunches in Scotland
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Energy balance
Levels of overweight and obesity are increasing, latest
figures show around 68.5% men and 61.8% women in
Scotland are overweight (including obese) (The Scottish
Government 2010).
Young women, especially teenage girls, often try to
control their weight by adopting very low energy diets
or smoking but restricted diets may lead to nutrient
deficiencies and other health consequences.
People of unhealthy weight may need guidance on
lifestyle changes to help them achieve a healthy
weight.
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Overweight and obesity amongst Scottish children
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Healthy lives, healthy people:
A call to action on obesity in England
In order to reduce the prevalence of overweight and
obesity in the population, energy balance needs to
be shifted. This can be done by reducing energy
consumed (consuming fewer calories), increasing
energy expended (increasing physical activity) or
both.
The government’s call for action focuses on the need
to reduce energy intake and emphasises that we all
have a part to play. In particular it calls for a reduction
in the energy content of the food supply and for the
food industry to reduce the number of calories
provided by their products.
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New SACN report on energy requirements
The average dietary energy requirements for infants,
children, adolescents and adults in the UK have been
revised. For example, for adults:
Population average : 2550kcal (10.6MJ)  2605kcal (10.9MJ) per day
Population average: 1940kcal (8.1MJ)  2079kcal (8.7MJ) per day
This does not mean that people have become more
active or that they should eat more. The new values
are based on more up to date methods, which have
provided us with greater understanding of current
physical activity levels.
© Food – a fact of life 2011
New SACN report on energy requirements
SACN have noted that population groups who are
overweight (body mass index of 25 kg/m2 or more)
are likely to benefit from reducing the amount of
calories consumed.
Increased physical activity is also likely to benefit
health, and may help reduce body weight particularly
if combined with a reduction in energy intake.
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(Daily mail 2011)
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Positive energy balance
Energy out
Activity
Energy in
Food and drinks
Being overweight and obese increase risk of: certain
cancers, heart disease, stroke and Type 2 Diabetes.
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Negative energy balance
Energy in
Food and drinks
Energy out
Activity
Underweight can lead to: hair loss, dry, patchy skin,
weakened immune system, osteoporosis, infertility and
heart failure
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Monitoring energy balance
• It is very important to achieve a healthy weight
• Body Mass Index (BMI) =
weight (kg)
. height (m) x height (m)
Recommended BMI range (kg/m2)
Underweight
less than 18.5
Normal
18.5 - less than 25
Overweight
25 - less than 30
Obese
30 - 40
Very obese
over 40
© Food – a fact of life 2011
Physical activity
• Physical activity through life is important for
maintaining energy balance and overall health.
• New UK wide activity guidelines published in 2011.
• All activities count – sit less, move more!
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Physical activity for children and
young people
(5-18 years)
All children and young people should engage in
moderate to vigorous intensity physical activity
for at least 60 minutes and up to several hours
every day.
Vigorous intensity activities, including those that
strengthen muscle and bone, should be
incorporated at least 3 days a week.
All children and young people should minimise
the amount of time spent being sedentary
(sitting) for extended periods.
Source: Department of Health (2011):
UK Physical Activity Guidelines
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Physical activity for adults
(19-50 years)
Adults should aim to be active daily.
Over a week, activity should add up to
at least 150 minutes (2 ½ hours) of
moderate intensity or 75 minutes of
vigorous intensity activity.
Adults should also undertake physical
activity to improve muscle strength on
at least two days a week and minimise
the amount of time spent being
sedentary (sitting) for extended periods.
Source: Department of Health (2011):
UK Physical Activity Guidelines
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Physical activity for older adults
(65+ years)
Older adults should aim to be active daily, for
at least 150 minutes (2 ½ hours) of moderate
intensity activity or 75 minutes of vigorous
intensity activity each week and minimise the
amount of time spent being sedentary (sitting)
for extended periods.
Older adults should also undertake physical
activity to improve muscle strength on at least
2 days a week. For those who are at risk of falls,
they should incorporate physical activity to
improve balance and co-ordination at least 2
days a week.
Source: Department of Health (2011):
UK Physical Activity Guidelines
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Dietary recommendations
We should consume a variety of foods from each of the
four main food groups of The eatwell plate:
Fruit and vegetables
Meat, fish, eggs, beans
and other non-dairy
sources of protein
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Bread, rice, potatoes,
pasta and other starchy
foods
Milk and dairy foods
For further information, go to:
www.nutrition.org.uk
www.foodafactoflife.org.uk
© Food – a fact of life 2011