The place of plant-based eating in dietary guidelines The Eatwell Guide and beyond

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1 The place of plant-based eating in dietary guidelines The Eatwell Guide and beyond Ayela Spiro Senior Nutrition Scientist Nutrition Science Manager The Moment for Plant based eating is Now University of Leeds 15 th March 2017 The bottom line At least 80% of premature heart disease, strokes and type 2 diabetes and 40% of cancers could be prevented through healthy diet, along with regular physical activity and avoidance of tobacco. WHO

2 Diet can help prevent cancer There are around 163,000 cancer deaths in UK 450 deaths every day Cancer Research UK 2017 Diet can help prevent CVD BHF

3 Overweight and obesity among adults Health Survey for England 2012 to 2014 (three-year average) Almost 7 out of 10 men are overweight or obese (66.4%) Almost 6 out of 10 women are overweight or obese (57.5%) Adult (aged 16+) overweight and obesity: BMI 25kg/m 2 5 Patterns and trends in adult obesity Healthy Diet: Lifecourse Healthy diet important for health throughout the lifespan promotes the achievement of healthy pregnancy outcomes; supports normal growth, development and aging; helps maintain healthful body weight; reduces chronic disease risks; Promotes overall health and well-being. But how do we know what a healthy diet or healthy dietary patterns are? 3

4 Why look at plant based dietary patterns? Nutrient intake and status Supplement studies Nutrients Foods green leafy veg, wholegrains, berries Vitamin E, C, B 12 and folate, flavonoids, omega-3 fatty acids Diets totality of diet may have synergistic and cumulative effects on health and disease Back to basics: Understanding FBDG Dietary Patterns Foods and drinks that make up dietary intake over time A customary way of eating The result of choices on many eating occasions over time, both at home and away from home Consist of multiple + interacting food components Are more predictive of overall health status and disease risk than are the individual foods or nutrients consumed 4

5 Healthy Dietary Pattern A combination of foods that s linked to good health when eaten with regularity Consuming one helps a person: Achieve and maintain a healthy body weight Obtain adequate nutrients Reduce risk of chronic disease Can be tailored to meet an individual s: Personal, cultural and traditional preferences Budget Defining a healthy dietary pattern for the UK Largely plant-based How did we get here? PHE

6 Food based dietary guidelines (FBDG) Turn evidence-based scientific knowledge and government recommendations on foods, nutrients and health into Simple messages to help consumers make informed choices about the foods, drinks and dietary patterns that promote good health. What are the Government recommendations? High intakes Energy intake (obesity) High intake Cholesterol High intakes High BP High intakes CVD & colorectal cancer Nutrient based CHO Free sugars Fat Sat fat 50% dietary E Population average 5% dietary E Population average 35% dietary E 11% dietary E Population average Population average Salt 6g Population average Fibre 30g AOAC Population average Food based F & V 5 a Day Population average Fish Red/ Processed meat High intakes Colorectal cancer 2 a week (2 x 140g), 1 oily 70g / d Individual target Individual target 6

7 How is this translated to segments of Eatwell Guide? Optimisation modelling Optimisation modelling Computerised way of finding a combination of foods that meets all the nutrient recommendations while at the same time being closest to current dietary Utilised the most recent intakes of commonly consumed foods in the UK (NDNS 2008/ /12 n= 1491, 56% woman) Most recent data on food composition Applying the revised government macronutrient and food recommendations (post SACN) for adults Looking at the fewest possible changes needed to achieve these. Mean consumption of food are altered such that adult dietary recommendations for foods and nutrients are achieved but deviates as little from current diet as little as possible Scarborough et al

8 Eatwell segment angles 39% 37% From 31% From 32% 4% What s happened with protein food section? The name of food group Beans, pulses, fish, eggs, meat and other proteins updated to place emphasis on certain food products that can be considered more environmentally sustainable. The change of name highlights the importance of plant-based proteins in a sustainable, healthy diet. Eat more beans and pulses 8

9 Is UK alone in promoting plant based FBDG? Where are these FBDG from? (Note proportion of plant-based foods) 9

10 Even in France! 10

11 Healthy patterns aligned Healthy eating guidelines (FBDG) OR Plant-based diets OR Mediterranean diet, can be classified as healthy eating patterns In research, these patterns are typically defined using a priori defined scores (HEI, DASH or Medi Score) or a statistical analysis of certain components Healthy pattern typically characterised by higher consumption of vegetables, fruit, wholegrains, low fat dairy, seafood, nuts, seeds, legumes lower intakes of fatty/processed meat, refined grains, sugars-sweetened foods & drinks, lower salt, lower saturated fat Advisory Report DGAC 2015 Observational studies that look at healthy vs less healthy dietary patterns show consistent evidence of decreased disease risk But healthy patterns also associated with other lifestyle and socioeconomic factors 11

12 Consistent patterns for health Examination of association between dietary patterns and health outcomes revealed consistency BUT allows great variety in the individual foods that people can eat to achieve better health One size doesn t fit all Fit with cultural, religious, preferences no need to give up food groups! Fruit & Veg Pulses/nuts/seeds Wholegrains Fish UK Healthy Eating High ratio PUFA/MUFA: SFA Meat Added sugars Salt Sat Fat Excess Alcohol Other FBDG Nordic MeDi 12

13 Translated to disease prevention advice WCRF Cancer Prevention Recommendations What changes would we need to make from current diet to meet our FBDG? 13

14 UK diet compared with recommendations Carbohydrates 50% of dietary energy 48.5% Free Sugars 5% dietary energy 11.7% (NMES) Fat 35% dietary energy 34.2% Saturated Fat 11% dietary energy 12.7 Fibre (AOAC) 30 g/d 18.6g Salt 6g/d 8.0g Fruits and Vegetables 5 portions of a variety each day 27% Bates et al Increase in wholegrain/high fibre CHO Increase in potatoes, rice, pasta and other starchy carbohydrates Particularly increase in wholemeal bread, potatoes and high fibre breakfast cereals Current 27.2, to new 36.7% Scarborough et al

15 Increase in fruit & veg Increase in fruit and veg (incl dried fruit) From current 28.8% to new 39.3% 342 to 526g/d (over 6 portions a day) But decrease in fruit juice Scarborough et al 2016 Meeting fibre recommendations 15

16 Change in protein intake Decrease in meat (red, processed and white) Increase in oily and white fish Increase in beans, pulses and legumes Current 14g/d to 26g/d Scarborough et al 2016 Other changes from current intake Decrease in dairy (particularly cheese) Decrease in sugars sweetened beverages, cakes, biscuits, confectionary Are all these changes acceptable to UK population? Model is based on average population data - a composite diet that is not consumed by anybody Optimisation cannot account for human behaviour! 16

17 Micronutrient quality % with average daily intakes below LRNI, by age and sex Bates et al Comparison to current diet Of 15 nutrients: 11 would increase, incl. n-3 fatty acids, iron, folate, potassium, vitamins C, D and E 4 would decrease (but less than 1%) but mean intake Zn would fall below RNI In addition, modelling does not account for differences in the bioavailability of nutrient Further work should explore this Scarborough et al

18 Healthy and sustainable! Eatwell guide Estimated to reduce GGE, water and land use DGAC - a dietary pattern that is higher in plant-based foods, and lower in animal-based foods is more health promoting and is associated with lesser environmental impact than is the current average U.S. diet. Sweden - Find your way to eat greener, not too much and to be active - eat healthily and in an environmentally friendly manner. Germany - Choose mainly plant-based foods. They have a health-promoting effect and foster a sustainable diet. Final remarks Evidence on relationship between health and diet is used to set out food based guidelines Eatwell Guide is a pictorial representation of UK dietary recommendations, which have been set by SACN and COMA, including recent recommendations on reductions in free sugars and increase in fibre Eatwell Guide similar to other FBDG in that it is encourages a largely plant based diet UK population needs to change dietary patterns this is a challenge! 18

19 Acknowledgement Many thanks to University of Leeds for hosting and the Alpro Foundation for inviting me to present For further information, go to: Why not follow us on 19