Food, climate change and human health

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1 Paolo Vineis Imperial College London and HuGeF Foundation Torino Food, climate change and human health Italian Embassy, London, 20 october 2014 Imperial College London

2 The worrying situation of non-communicable diseases (NCD) today: the total burden is increasing because of demographic changes (ageing populations, increasing size), and Westernization of lifestyles However: 45% of cancers in men and 40% in women could have been prevented had risk factors been reduced to the optimal levels or eliminated (=> 5 servings of fruit and vegetables; =>23 g/day of fibers; <=6 g/day of salt; BMI<=25 kgm -2 ; physical activity=> 30 min 5 times/week; breastfeeding at least 6 months). Reduction/elimination of the same risk factors would lead to a substantial reduction also of cases of cardiovascular disease, renal disease, hepatic disease, diabetes and possibly some neurological diseases. (Vineis and Wild, Lancet 2014)

3 Trends in incidence of cancer in selected countries: age-standardised rate per 100,000, men Trends in cancer incidence, men all Cancer cancers, in from 5 Continents, Globocan IARC

4 Body weight and breast cancer More than 100 studies show that excess body weight increases the risk of postmenopausal breast cancer RR level off near BMI 28 in high-risk countries but not in low- to moderate risk countries Adult weight gain is a strong predictor of postmenopausal breast cancer risk in EPIC, a UK-Italy partneship

5 EPIC Collaborating centres and cohort subjects Subjects included Questionnaire Q + Blood France Italy Spain UK Netherlands Greece Germany Sweden Denmark Norway All OVIEDO SAN SEBASTIAN COPENHAGEN CAMBRIDGE UTRECHT POTSDA OXFORD BILTHOVEN M PAMPLONA PARIS IARC MILAN LYON TURIN FLORENCE MURCIA GRANADA TROMSØ AARHUS BARCELONA UMEÅ MALMÖ HEIDELBERG NAPLES RAGUSA ATHEN S

6 EPIC Time Table BASELINE Subjects recruitment Questionnaires data Anthropometry data Blood/DNA collection Data Base & Biorepository ETIOLOGICAL STUDIES FOLLOW-UP: Cancer diagnosis Vital status Causes of death Changes in Lifestyle Development of common/standardized Nutrient and lifestyle Data Bases Setting up of lab facilities for sample handling / DNA extraction etc

7

8 Bacterial metabolism in colon SCFA Butyrate Lower ph Apopotosis? g fibre leaves the small bowel Bacterial mass Reduced transit time, dilution,less mucosal contact Mechanism of action of dietary fibre (and resistant starch)

9 Fibre intake and total mortality The RRs were estimated by Cox proportional hazard model. Solid line indicates RR, and dash lines indicate 95% confidence intervals derived from restricted cubic spline regression, with knots placed at the medians of each quintile of the distribution of fibre intake. The reference point for fibre intake is 25 g/day. The models excluded the first two years of follow-up and were stratified by age at recruitment, sex, and center, and adjusted for education, smoking, drinking, body mass index, physical activity and total energy intake (kcal/day).

10 Westernization of lifestyle and cancer. Western Lifestyle: - Energy dense diet, rich in - fat, - refined carbohydrates - animal protein - Low physical activity - Smoking and drinking Consequences: - Greater adult body height - Early menarche - Obesity - Diabetes - Cardiovascular disease - Hypertension and cancer!

11 What is missing to our knowledge? Better characterization of exposures and of intermediate steps e.g. via biomarkers and omics These could be used to monitor preventive policies and for the development of healty foods

12 Supervised analysis defined urinary profiles robustly associated with known dietary factors (Nature 2008)

13 Climate change

14 Modelled impact of climate change on global cereal grain production: % change, (Tubiello and Fischer 2006) % Change (range) World -0.6 to -0.9 Developed countries +2.7 to +9.0 Developing countries -3.3 to -7.2 Southeast Asia -2.5 to -7.8 South Asia to Sub-Saharan Africa -3.9 to -7.5 Latin America +5.2 to +12.5

15 A win-win strategy? Acting in multiple sectors may prevent many more diseases (Series of papers by Haines in Lancet )

16 Food and Agriculture Sector 80% of total emissions in sector from livestock production Reducing animal source saturated fat by 30 % in the UK could reduce heart disease deaths by ~ 15% (~ 18,000 premature deaths)

17 Proposal for an academic-industry partnership Research institutions have now extensive know-how and material resources to answer some key questions concerning the epidemic of NCD and the effects of climate change (e.g. large longitudinal studies with dietary information and biobanks with millions of subjects recruited; metabolomic and epigenetic high-throughout tools ) Collaboration with industry is needed to help identify the relevant research questions, to elaborate an overarching strategy towards healthy food and reduction of carbon emissions, and to develop new technologies that can be scaled-up Italy and UK may play a key role. Italy has a long-standing tradition of high-quality food industry and a strong, deeply-rooted food culture. UK and Italy have developed excellent examples of collaboration on health effects of food and climate change (e.g. Imperial-HuGeF-EPIC network)

18 However, a problem to consider is potential conflict of interest. A single industry can hardly fund research institutions, given the uncertainties on the health impact (hazardous or protective) of single foods. This raises conflicts of interest and lack of fairness towards other potential partners. A good model has been proposed in relation to electromagnetic fields in France (ANSES) and air pollution in the US (HEI), i.e. multiple industries fund a new independent institute that releases competitive calls with independent evaluation panels. what next? See you at EXPO2015

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