Prof.dr. Frans J Kok. Nutrition & Health Perspectives over the Life course

Transcription

1 Prof.dr. Frans J Kok Nutrition & Health Perspectives over the Life course

2 Midlife Early life Midlife Late life

3 Double Burden of Malnutrition

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5 Global population in 2015 and 2060

6 Modern Science and Technology Diet Individual biology at multi-level Topol EJ. Cell 2014

7 Late life Midlife Early life nutrition

8 Early life HIGH BURDEN OF UNDERNUTRITION Low Calories Protein Intake Big Five problem nutrients iron, vitamin A, iodine, zinc, folic acid Bhutta ZA. Lancet 2013

9 Early life REDUCED GROWTH IN CHILDREN UNDER 5 YEARS 10-20% 20-40% > 40% Stunted obesity FAO 2013

10 Early life Malnutrition responsible for half of child deaths anaemia, blindness, birth defects stunting, cognitive & motor impairment

11 Death of 1 million children per year can be prevented by 10 proven nutrition interventions. SAM = Severe Acute Malnutrition (WHZ < -3SD) MAM = Moderate Acute Malnutrition (WHZ < -2SD and >= -3SD) Bhutta et al. Lancet 2013

12 Early life 1000 days have a lifelong impact

13 Early life Cognitive Iron builds a better brain

14 Early life IRON SUPPLEMENTATION IMPROVES MENTAL DEVELOPMENT RTC 6000 pregnant women 4600 live births Chang S. Pediatrics 2013 Chang S. Pediatrics 2011

15 Early life We are neglecting adolescent girls' nutrition

16 Early life Chromosome Histone modification DNA-methylation Epigenetics

17 Early life Hungry Harvest Domingues-Salas P. Nat Commun 2014

18 Late life Early life Midlife nutrition

19 Midlife Obesity Lancet series

20 Midlife 5% weight loss only Calories count Johnston BC. JAMA 2014 Sacks FM. N Engl J Med 2009

21 Midlife

22 Midlife unhealthy week healthy week

23 Midlife UNHEALTHY CHANGES IN BODY unhealthy month PARAMETERS worse blood lipids high blood pressure higher heart rate increased insulin increased belly fat high liver enzymes lower fitness

24 Midlife Conclusions n=1 Self-experiment Experiment is scientifically designed: within-person variation, controlled protocol No scientific conclusions: chance-findings, repeated experiments with more subjects for valid outcomes However. A clear trend in the findings: small but adverse changes, which can be restored

25 Midlife BMI=36.2 BMI=22.8 Excess belly fat

26 Midlife STRESSED FAT CELLS LEAD TO INFLAMMATION infiltrated immune cells immune cells release signals Chawla A. Nature Rev Immunol 2012 stressed fat cell

27 Midlife immune cell adipocyte Johnson AR. Immunol Rev 2012

28 Midlife Wageningen Belly Fat study design Wageningen Belly Fat study design N = 40 N = 40 N = 30 Western diet Targeted diet Control usual diet -30% caloric restriction no caloric restriction

29 Midlife BODY WEIGHT & LIVER FAT DECREASED usual diet Western diet Targeted diet Control kg kg kg - 48 % - 57 % + 24 %

30 Change in SAT (log2 cm 2 ) Change in VAT (log2 cm 2 ) Change in VAT/SAT ratio (log2) Body fat distribution Western-type diet: n=28 Targeted diet: n=26 Control group: n=16 Subcutaneous adipose tissue mass Visceral adipose tissue mass

31 Insulin sensitivity Baseline Change after 12 weeks p-value HOMA-IR Western-type diet group Targeted diet group Control group 3.8 ± ± ± ± 2.3 a -1.0 ± 1.5 a 0.1 ± 1.5 b QUICKI * Western-type diet group Targeted diet group Control group 0.33 ± ± ± ± 0.03 a,b 0.02 ± 0.03 a 0.00 ± 0.02 b *Quantitative insulin sensitivity check index 31

32 HDL cholesterol Targeted diet group Western-type diet group Lipids Lipids Phospholipids Phospholipids X Large HDL (particle concentration) Cholesterol Cholesterol esters Cholesterol Cholesterol esters X Large HDL (particle concentration) Free cholesterol Free cholesterol Lipids Triglycerides Triglycerides Lipids Phospholipids Phospholipids Large HDL (particle concentration) Cholesterol Cholesterol esters Cholesterol Cholesterol esters Large HDL (particle concentration) Free cholesterol Free cholesterol Triglycerides Lipids Lipids Triglycerides Phospholipids Phospholipids Medium HDL (particle concentration) Cholesterol Cholesterol esters Cholesterol Cholesterol esters Medium HDL (particle concentration) Free cholesterol Free cholesterol Lipids Triglycerides Triglycerides Lipids Phospholipids Phospholipids Small HDL (particle concentration) Cholesterol Cholesterol esters Free cholesterol Cholesterol Cholesterol esters Free cholesterol Small HDL (particle concentration) 32 Triglycerides Triglycerides

33 Midlife Wageningen Belly Fat study Wageningen Belly Fat study

34 Diet Individual biology at multi-level Topol EJ. Cell 2014

35 Midlife Integrating multi-level data Topol EJ. Cell 2014

36 Midlife One size fits all

37 Midlife Early life 117 years old Late life nutrition

38 Late life Theory of aging programmed damage López-Otín C. Cell 2013

39 Late life physiological integrity The aging process organ function quality of life disease risk atherosclerosis carcinogenesis osteoporosis cognitive decline sarcopenia

40 Late life Aging brain Cognitive decline Dementia

41 Late life 30% OF ALZHEIMER CASES DUE TO LIFESTYLE normal Alzheimer Norton S. Lancet Neurol 2014

42 Late life INTERVENTION KEEPS THE MIND 'SHARP' total score executive functioning Z-score 1y 2y 1y 2y processing speed memory 1y 2y 1y 2y 2 year RCT, at-risk elderly aged y, n=591 intervention, n=599 control 2 year RCT, 1190 elderly aged y Ngandu T. Lancet 2015

43 Late life MIXED RESULTS ON COGNITION Durga J. Lancet 2007 van de Rest O. Neurology 2008 Van der Zwaluw N. Neurology 2014

44 Late life B-VITAMIN REDUCES LOSS OF GRAY MATTER reduced loss of gray matter before after 2 year RCT, Douaud 156 elderly, G. PNAS y, intervention B12, B6 & Folic acid 3.2% less loss Douaud G. PNAS 2013

45 Late life STROOP TEST STUDIES BRAIN CONNECTIVITY YELLOW BLUE ORANGE BLACK RED GREEN PURPLE YELLOW RED ORANGE GREEN BLACK BLUE RED PURPLE GREEN BLUE ORANGE Taya F. Front Syst Neurosci 2015

46 Late life USE IT OR LOSE IT muscle mass fat mass man 25 years man 63 years

47 Late life muscle mass (%) MUSCLE LOSS WITH AGING % age (yrs) Short K, Nair S. 2000

48 Late life type 2 muscle fibers Exercise training gives muscle strength

49 Late life Exercise & protein beneficial for elderly 1.5 change in lean body mass (kg) Placebo Protein -0.5 Tieland M. J Am Med Dir Assoc 2012

50 Late life 1 kg muscle mass loss in 7 days

51 Late life PROTEIN ENRICHED FOODS IMPROVED MUSCLE STRENGTH 6 month RCT elderly patients - 77 y -Cater with Care versus Standard Care

52 Late life Jankovic N. Am J Epidemiol 2014