Transcript High skill base, time consuming, “food”

Healthy eating for middle-years
Professor Tom Sanders
Nutritional Sciences Division
Major causes of premature death
in middle-aged subjects
• Smoking related illness
• Alcoholism
• Diet related disease – cardiovascular
disease and type 2 diabetes
• Cancer
2
Storing fat in the
wrong place
Metabolic syndrome
High
LDL-C
Metabolic
Syndrome
Type 2
Diabetes
Coronary Heart Disease
Relative Risk of Diabetes
with increasing BMI
45
40
35
30
25
20
15
10
5
0
<23
23-24.9
25-29.9
30-34.9
>35
What is driving obesity
Decreased physical activity
Increased energy intake among the
susceptible
Increased access to high energy density
foods especially outside the home
Effect of fat additions on energy density
Chapati made with fat
Chapatis made without fat
Chicken fried
Chicken
Fried rice
Boiled rice
Cod fried in batter
Cod baked
French fries
Boiled potato
0
50
100
150
200
kcal/100g
250
300
350
Fast Food
Slow Food
High skill base, time
consuming, “food”
focused
SCRATCH
COOKING
e.g. primary
products,
traditional
grocery
COMPONENT
COOKING
e.g. prepared
vegetables,
prepared
meat/fish,
sauces, pizza
Convenient
social
READY
MEALS
TAKE-AWAYS
SNACKING
‘ON THE
HOOF’
DELIVERY
QSR
RESTAURANT
e.g.
Sandwiches,
Sushi
Physical activity
Physical inactivity
© WorldpanelTM division of TNS 2003
What we know about obesity
management
• Calorie intake must be decreased (no
clear difference between fat and
carbohydrate calories)
• Portion control is crucial
• Avoid temptation – “Willpower lasts 2
weeks and is soluble in alcohol”
Fat patterning associated with
metabolic syndrome
Obesity and metabolic syndrome
• Obesity contributes to causing
metabolic syndrome
• Physical activity is protective
• A diet high in rapidly absorbed
carbohydrate (both starch and sugar)
makes metabolic syndrome worse
Healthy artery
Atherosclerosis
(chronic)
Thrombosis
(acute)
15
16
Health Survey 2003 England & Wales
80
% with hypertension
70
60
All
Treated
Untreated
50
40
30
20
10
0
16-24
25-34
35-44
45-54
Age group
55-64
65-74
75+
Dietary factors contributing to raised
blood pressure
• Overweight
• Excess alcohol intake
• Low intake of fruit and vegetables
• High salt intakes
19
Dietary factors influence blood
cholesterol
• Overweight
• High intake of saturated fat
• Unfiltered or boiled coffee (usually not
significant unless large amounts
consumed
21
• Cholesterol in foods such as eggs
(small effect)
Intake of long chain n-3 fatty acids in 41,578 Japanese men and women and risk
of CHD over 10 years
Iso et al. Circulation 2006;113:195-202.
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Risk of sudden death adjusted for risk factors in men enrolled in
the Physicians Health Study
Relative risk
1.0
0.5
0.0
3.58
4.76
5.63
6.87
% long-chain n-3 fatty acids in blood lipids
Albert et al. N Eng J Med 2002; 346:1113-8
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GISSI_HF
Lancet 2008 Editorial
“A simple and safe
treatment with n-3 PUFA
can provide a small
beneficial advantage in
terms of
mortality and admission
to hospital for
cardiovascular reasons in
patients with heart failure
in a context of usual
care.
George Davey Smith
Lancet Jan 2009
“A reasonable
interpretation of the GISSIHF trial would be that the
modest estimated effect of
fish oil requires
replication.”
UK government recommendation on intakes in relation to
reducing risk of cardiovascular disease
Aim to consume two portions of fish per
week one of which should be oily
Providing ~3g long-chain n-3 PUFA/week
or 0.45g/d
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Effect on risk of CHD events of replacing 5% energy saturated fatty
acids from pooled analysis of 11 cohort studies
Jakobsen M et al. Am J Clin Nutr 2009;89:1-8.
Dietary advice to prevent heart disease
• Avoid overweight/obesity
• Replace sources of saturated fat with
unsaturated fat (i.e. liquid oils for hard fats)
• Eat more fish especially oil fish and less fatty
meat
• Cut down on salt
• Avoid excessive consumption of sugar
sweetened drinks and alcohol
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21st November 2006: FDF GDA Briefing
A
Cheddar
B
Reduced fat
cheddar
21st November 2006: FDF GDA Briefing