What is the global nutrition transition?

Transcription

1 What is the global nutrition transition? In the same countries, one finds malnutrition and obesity. The appearance of obesity in these locales has been called the Nutrition Transition What underlies this transition are changes in diet resulting from the introduction of Western foods in place of traditional plant-based diets.

2 Plant-Based Diets Western Diet Pattern Subsistence Agriculture Food Scarcity Malnutrition Industrial Agriculture Government Subsidies Increased Availability Poor Food Quality Obesity and Chronic Diseases

3 What are the differences? vs % Fat 2. Omega-6/omega-3 ratio 3:1 3. Good Fructose with Antioxidants Fiber, Water, Few Calories 4. Plant Proteins with lower calories can be prepared with little fat. 5. Rich in Vitamins, Minerals, and Micronutrients to 50% Fat Calories 2. Omega-6/omega-3 ratio 10-30:1 3. Bad Fructose as HFCS with High Calories, Low Fiber, Low Antioxidants id t 4. Animal Protein with Saturated Fat and Increased Calories 5. Poor in Vitamins, Minerals and Micronutrients

4 Fat Increases after 1980 Sweetener Increases after 1985

5 High Fructose Corn Syrup (HFCS) HFCS was rapidly introduced to many processed foods and soft drinks in the U.S. from about 1975 to High-fructose corn syrup is produced by milling corn to produce corn starch, then processing that starch to yield corn syrup, which is almost entirely glucose, and then adding enzymes that change most of the glucose into fructose. The resulting syrup (after enzyme conversion) contains approximately 90% fructose and is HFCS 90. To make the other common forms of HFCS (HFCS 55 and HFCS 42) the HFCS 90 is mixed with 100% glucose corn syrup in the appropriate ratios to form the desired HFCS.

6 Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity Estimated intakes of total fructose ( ), free fructose ( ), and high-fructose corn syrup (HFCS, ) in relation to trends in the prevalence of overweight ( ) and obesity (x) in the United States Source: George A Bray, Samara Joy Nielsen and Barry M. Popkin, American Journal of Clinical Nutrition, Vol. 79, No. 4, , April 2004.

7

8 Good Fructose vs. Bad Fructose Good Fructose Fruits** Vegetables** Whole Grains** **Antioxidants and Fiber, Nutrient Dense and Lower Calories Bad Fructose Soft Drinks Snack Foods* Candy* Pastries, Cakes* *With hidden fats

9 Nutrition 101 Protein Fat Carbohydrates Amount and Quality relative to Lean Body Mass Amount and Quality relative To Fat Mass Limited Amount Stored (300 g) Burn Daily Commonalities: Both Essential for Good Health Both Missing from Modern Diet Both Stored in the Body Long-Term Simple Sugars or Refined Carbs Vs. Plant-Based Carb/Fiber Mix Healthy Active Lifestyle Lessens the Impact of Poor Diet

10 What are the results? Worldwide epidemic of obesity and overweight. Increases in type 2 diabetes. Association with multiple inflammatory diseases such as asthma, arthritis, heart disease, and common forms of cancer. Increased health care costs due to overutilization of services.

11 BODY MASS INDEX (W/H 2 ) UNCOVERS THE USA EPIDEMIC OF OBESITY AND, THE USA EPIDEMIC IS SPREADING INTERNATIONALLY WITH RURAL TO URBAN MIGRATION AMERICA EXPORTS OBESITY TO THE WORLD!!!

12 Definition of obesity Obesity is defined as excess body fat (not simply excess weight.)

13

14 Even if you are thin you can be fat MRI reveals fat around the Heart, Liver and Intestine in Individuals with Normal Waist Circumference Of the women scanned by Bell and his colleagues, as many as 45 percent of those with normal BMI scores (20 to 25) actually had excessive levels of internal fat. Among men, the percentage was nearly 60 percent.

15 Relationship Between BMI and Percent Body Fat in Men and Women Body Fat (%) 70 Women 60 Men Body Mass Index (kg/m 2 ) Adapted from: Gallagher et al. Am J Clin Nutr 2000;72:694.

16 Intra-Abdominal fat Macrophage and the Innate Immune System Pro-Inflammatory Cells Ingress Mediates the Inflammatory State of Adipose Tissue

17

18

19 The Immune System comprises 1.Tonsils and Adenoids 2. Lymph Nodes 3. Spleen 4. Peyer s Patches 5. Appendix 6. Bone Marrow 7. Tissue Lymphatics

20 FOCUS ON ABDOMINAL OBESITY ESPECIALLY IN ASIANS AND IN LEAN AND OVERWEIGHT NON-OBESE

21

22 Millions of cases of diabetes around the world In 2000 with projections for 2030 and % increase

23 Phytochemicals, Phytonutrients Phenolics (e.g ferulic acid, caffeic acid) Polyphenols Glucosinolates Ellagic acid/ellagitannins Flavonols (e.g. quercetin) Flavonoids Isoflavones (genistein, daidzein) Flavanones e.g. hesperidin Flavanolsl Anthocyanins Catechins Pro(antho)cyanidins

24 ABOVE FIGURE IS A FLAVONE IF R4 is a Ketone group then this is a Flavonoid IF R3, R4, and double bond C1-C2 = anthocyanin

25 Citrus/Naringin Apigenin/Parsley Tea, Cocoa, Grapeseed Berries Relationships Among Flavonoid Structures Analogous Structures in Different Species

26 Color Code for Fruits and Vegetables Red - Tomato products, soups, sauces, juices Red/Purple - Red Wine, Grapes, Berries, Plums Orange - Carrots, Mango, Apricot, Sweet Potato Orange/Yellow - Citrus Fruits, Papaya, Peaches Yellow/Green - Spinach, Corn, Avocado, Green Beans Green - Broccoli, Brussels Sprouts, Cabbage White/Green - Garlic, Onions, Chives, Asparagus

27

28 Total Nutrition Solution Balance Energy Intake and Expenditure to Reduce Abdominal Fat Increase ω-3 Fatty Acids Decrease ω-6 Fatty Acids Increase Good Fructose and Limit Refined Sugars Increase Antioxidants and Phytochemicals Increase Fiber Intake for Digestive Health Multivitamin/Multimineral Calcium and Vitamin D Targeted Supplements Protein-Rich Shakes, Healthy Meals and Snacks and Activity/Exercise Ocean Fish and Fish Oils Eat Less Hidden Fat Limit Soft Drinks, Cakes, Pastries, Cookies, Candy 7 Servings Per Day of Colorful Fruits &Vegetables 25 grams of fiber Soluble and Insoluble Personalized Nutrition

29 What is the Solution? The Mission for Nutrition International efforts at lifestyle change through the provision of healthy nutritional products and education in healthy active lifestyles. Grassroots efforts at the community level. Medical and Healthcare Industry understanding of the issues involved to enable leadership in prevention efforts.

30 International incidence of prostate cancer Shanghai, China Hong Kong Miyagi, Japan Ragusa, Italy L.A. (Chinese) Costa Rica Scotland Finland L.A. (Japanese) Canada USA (White) USA (Black) Rate per 100,000 Source: Dijkman and Debruyne, Eur Urol 30:

31

32 Will weight loss impact on prostate cancer progression? Diet and Exercise Program Approximately 10% Kcal Fat 70% Calories from complex carbohydrates vegetables, fruits, legumes, whole grains Protein primarily non-animal source except for fish, poultry Walking at training heart rate (70 85% of maximal rate) minutes 5 days weekly

33 Cell Growth (% of Control) LNCaP Cell Growth in Serum of Men Undergoing An Eleven-Day Diet and Exercise Intervention (n = 13) Day 1 Day Subject

34 Dietary fat Epidemiologic Studies: Correlation between high dietary fat (red meat and corn oil) and incidence and mortality from CaP

35 Dietary fat (corn oil) and LAPC-4 tumor growth In Vivo umor Volume (cc) T 0.8 High-Fat (42% kcal) ** ** Low-Fat (12% kcal) N = 14, **p<0.01 ** Time (Weeks) * ** ** ** PSA 105 PSA 60

36 Type of Dietary Fat Omega-3 vs Omega-6 Omega-3 (DHA, EPA) in fish oil Cold water fish (salmon, tuna, mackerel, trout, t herring, sardines) Farmed talapia and catfish (high omega-6:omega-3 ratio) Epidemiologic studies US Diet 20:1, Asian diet 4:1 Ratio of omega-6: omega-3 fatty acids is important Effects on membrane ratios, COX-2 and inflammation and proliferation in our Human Trial Other healthy fats monounsaturated What about Flax Seed?

37 Role of antioxidants for CaP prevention Estimated 50% of cancers result of environmental pro-oxidant factors Ongoing g balance between DNA damage and repair (pro and anti-oxidants) Antioxidants, Phytochemicals appear to favorably tip the scales UV Radiation Environmental Pollutants Obesity Benign PIN Prostate Cancer Physiological Chem Rxns Burnt Meat/Saturated Fat

38 Selenium Vitamin E SELECT Trial Results Use caution with excessive use of vitamins and supplements

39 Polyphenols Antioxidants that form the colors in fruits and vegetables Chemicals produced by plants to protect from pathogens and environmental oxidants What Color is Your Diet?

40 Tomato Sauce - Lycopene Lycopene potent antioxidant, effectively scavenges reactive oxygen species 2+ servings of tomato sauce per wk - decreased risk of CaP Sauce more effective than fresh tomatoes Effect on prostate tissue

41 Cruciferous Vegetables Broccoli, cauliflower, cabbage brussel sprouts, bok choy rich in antioxidants (isothiocyanates) Study findings

42 Pomegranate Among the riches sources of polyphenols 1-Arm UCLA Human Trial in men with rising PSA following primary therapy. PSA Doubling time increased from 15 to 37 mo Multisite randomized study

43 Green/black tea Tea high in polyphenols (catechins) Clinical trial results - prevention

44 Soy Protein Epi studies and tissue culture studies Conclude: natural soy in whole foods tofu, miso soup, is good source of non-animal protein Recommend against powder supplementation

45 Take Home Message Maintain Healthy Weight Fat and Protein Fat: 25-35% Kcal fat, choose healthy fats, corn oil in moderation > 2 servings fish/wk high in omega-3 fatty acids (salmon, mackerel, lake trout, herring, sardines, albacore tuna) Avoid burnt, charred meats, eat red meat in moderation Chicken breast, tofu Carbohydrates 5+ servings fruits/vegetables daily, complex carbohydrates Avoid simple sugars promote fat deposition and obesity Cruciferous vegetables 2 servings tomato sauce/wk 20-30gm fiber/day from complex carbohydrates Pomegranate Juice in moderation

46 Take Home Message For caffeine drinkers: replace coffee with green/black tea? Vitamin E > 400IU day NO Lifestyle Changes Increase daily activity Walk whenever possible, take the stairs Walk/exercise at training heart rate (70 85% of maximal rate) minutes 5 days weekly

47 The New York Times

48

49 Newsweek

50

51 Source: Fontana L et al. Science 2010

52 Calorie restriction without malnutrition increases healthspan and lifespan up to 50% in rodents Masoro EJ. Mech Ageing Dev Weindruch R. N Engl J Med 1999

53 ~30% of the CR rodents dies without any gross pathological lesion 6% No pathological lesions at necropsy in 22 of 79 CR rats No pathological lesions at necropsy in 5 of 80 28% Ad-libitum fed rats Shimokawa I et al. J Gerontol 1993

54 Calorie restriction reduces cardiovascular and cancer mortality by 50% in non-human primates P = 0.03 HR = 3.0 Ad libitum CR P = HR = 2.9 Colman et al. Science 2009

55 Calorie restriction reduces the age-associated brain atrophy in non-human primates Colman et al. Science 2009

56 Calorie restriction improves memory in elderly humans Witte et al. PNAS 2010

57 Cardiometabolic risk factors CR EX WD P value Total cholesterol (mg/dl) 162±36* 166±35* 202± LDL cholesterol (mg/dl) 88±24* 92±26* 122± HDL cholesterol (mg/dl) 63±19* 61±17* 50± T Chol/HDL Chol ratio 2.7±0.5* 2.8±0.6* 4.3± Triglycerides (mg/dl) 58±18* 65±22* 159± SBP (mm Hg) 103±9*, 125±17 131± DBP (mm Hg) 62±7*, 72±8* 84± Fasting glucose (mg/dl) 82±7*, 90±7 95± hscrp (mg/l) 0.2±0.3*, 0.8± ± Fontana et al., PNAS 2004 unpublished data

58 CR practitioner before starting CR and after 7 years of CR Body weight 180 lb or 81.6 kg (BMI 26.0 kg/m 2 ) 134 lb, or 60.8 kg (BMI 19.4 kg/m 2 ) T chol and LDL c 244 mg/dl and 176 mg/dl 165 mg/dl and 97 mg/dl Fasting glucose 87 mg/dl 74 mg/dl Blood pressure 144/87 mmhg 94/61 mmhg

59 Long-Term Caloric Restriction Ameliorates the Age-dependent Decline in Diastolic Function Comparison of Transmitral Filling Patterns Meyer T et al. JACC 2006

60 Extending Healthspan to Equal Lifespan Survival Age (years)