Healthy dietary habits - how to promote positive changes?

Transcription

1 Healthy dietary habits - how to promote positive changes? Ulla Toft Post doc researcher Research Center for Prevention and Health World Health Organization 10-15% of all years of lifes lost in Europe are due to unhealthy diet About 30% of all death due to cardiovascular disease could be prevented through healthier diet

2 The effect of dietary changes in controlled clinical trials Saturated fat: Oslo Diet-Heart study: 25% reduction in trombosis Fish: Dart study: 29% reduction i mortality Mediterranean Diet: Lyon Diet Heart Study: 70% reduction i mortality Dietary habits in the Danish population The share of people who meet the dietary recommendations 120 Percent grams of fish per week 30E% fat 10E% saturated fat 600 gram of fruit and vegetables 4

3 Individualbased dietary counselling to promote healthier dietary habits Is it possible to promote healthy long-term dietary changes in a large general population?

4 The Inter99 study A large randomised life-style intervention study for prevention of ischaemic heart disease in the general population Toft et al: Prev Med Oct;47(4): Flow chart Inter99 Study population of Inter99: 61,301 subjects A High intensity intervention 11,708 B Low intensity intervention 1,308 C No intervention 5,264 out of 48,258 group intervention High risk Low risk High risk Low risk baseline : questionnaires, health-examination, life-style consultation Year 1 Year 3 Follow-up in central registries Year 5 : questionnaire only

5 Individual lifestyle counselling Motivational Interviewing Health Belief Model, Social Cognitive Theory, Transtheoretical Model Nuværende risiko PRECARD Risiko efter ændring af livsstil

6 Diet- and exercise counselling groups participants 6 meetings 4-6 months Education Personal goals Family members 11 Methods and analyses Dietary goals Measurement 48 item food frequency questionnaire Analyses Multi level, longitudinal regression analyses with random effects

7 Development in the intake of salads and cooked vegetables Women 5 year: P= year: P=0.04 Men g/week g /w eek * * * g/w g/week * * * Year Intervention Control Year Intervention Control Results are adjusted for age, sex, smoking, physical activity, alcohol, education, employment, living with partner, perceived risk associated with dietary habits and self-rated health. *Difference in intake between intervention and control group, P<0.05; : P value for difference in the development in intake Odds ratio for using saturated fats on bread and for cooking Women 1 year: P< year: P< Men 1 year: P= year: P< ,2 5 year: P< ,2 5 year: P= O d d s rati o 0,8 0,6 0,4 0, Year Odds r ati o 0,8 0,6 0,4 0, Year Intervention Control Intervention Control Results are adjusted for age, sex, smoking, physical activity, alcohol, education, employment, living with partner, perceived risk associated with dietary habits and self-rated health. : P value for difference in the development in intake

8 Flow chart Inter99 Study population of Inter99: 61,301 subjects A High intensity intervention 11,708 B Low intensity intervention 1,308 C No intervention 5,264 out of 48,258 group intervention : questionnaires, health-examination, life-style consultation : questionnaire only High risk Low risk High risk Low risk baseline Year 1 Year 3 Year 5 Follow-up in central registries Development in unsaturated/saturated fat ratio 1,6 1,55 1 year: P= year: P= year: P=0.01 Unsaturated/saturated fat 1,5 1,45 1,4 1,35 1,3 1,25 * 1, Year Group A Group B Results are adjusted for age, sex, smoking, physical activity, alcohol, education, employment, living with partner, perceived risk associated with dietary habits, self-rated health, total fat and energy intake. *Difference in intake between intervention and control group, P<0.05; : P value for difference in the development in intake between groups.

9 Development in fish intake year: P= year: P= year: P=0.05 gram fish pr day Year Group A Group B Results are adjusted for age, sex, smoking, physical activity, alcohol, education, employment, living with partner, perceived risk associated with dietary habits and self-rated health. : P value for difference in the development in intake between groups. Conclusion Multi-factorial lifestyle intervention promoted significant healthy long-term dietary changes in a large general population. Group-based counselling promoted maintenance

10 The overall evidence Good evidence that individual counselling can promote moderate positve changes in the dietary intake of individuals with a high risk of disease. The long term effect is unclear. The effect of multi-factorial lifestyle intervention on CVD mortality S Ebrahim (systematisk cochrane review)

11 Lifestyle changes (effect of individual intervention) Læklææklælk End of the intervention Intervention Kontrol 7 5 Baseline 1 år 2 år 3 år 4 år 5 år 6 år 7 år 8 år Many factors affect dietary habits Preferences Age Availability Norms Position Social networks Culture Sex Legislation Motivation Knowledge Portion sizes Health Price Time Regulation

12 Factors affecting dietary habits The individual Sex Age Motivation Position Preferences Knowledge Self-efficay Factors affecting dietary habits Legislation Structure Physical environment Availability Price Regulation Work place Norms Social networks Role models Supermarket Fastfood restaurants Culture The individual Sex Motivation Preferences Age Knowledge Self-efficay

13 Availability - canteens Fruits og salads + price: Sale increased with a factor 3 Moving unhealthy snacks: 13-15% reduction in sale Fat in the canteen food: Fat intake by 6-12 energy percent Alcohol intake in the UK in relation to the alcohol price Liter ren alkohol pr. person (alder 15+) Price regulation - alcohol Alkohol Pris Pris relativt til indkomst

14 Price regulations - Milk 1983: Price: Whole milk: 25% Semi-skimmed milk: 10% Skimmed milk: 5% 1984: Sale Whole milk: 25% Semi-skimmed milk: 27% Skimmet milk: 18% Ottawa charter 1986 Make the healthier choice the easier choice

15 2011: Is the unhealthier choice the easier choice? Portion sizes A strong predictor of energy intake

16 The sugar intake has increased by a factor three Children and adolescents eat 320 kg of candy and 140 liters of sugary beverages per year Sugary sodas: from 250 ml occationally to 2 liters often Candy bags: 50 g to 1 kg tubs Take three, pay for two Standard meal at a fast food restaurant 1985: 625 kcal 2005: 1450 kcal

17 Salt Salt intake in Denmark: 10-11/8-9 g in men/women WHO recommends <5 g 3 g salt: 14% stroke=1600 strokes per year saved 70% of the salt intake comes from processed foods Canteen meals: 3.4 g salt/meal or 14.6 g/10 MJ (Rasmussen et al, 2010) Ex. 1 pizza with meat/fish: 11.3 g salt Is it a free choice to eat a healthy lunch?

18 Or to buy healthy foods? Default The computer world Defaults: settings that most people would choose anyway. Makes optimal use possible without a great effort from the user Sundhed Simplify the choices of the individuals, so that most people choose the product they would have chosen if they had the time to think.

19 Defaults 2011 Big bottles, bags and boxes We buy more Availability Food, snacks and drinks at any time Advertisment The more unhealthy the more advertisment The location of foods in the supermarket Affect our choices Result: We have to fight against an unhealthy default Most of our choices are not rational, conscious choices Conclusion To promote healthier dietary habits: A combined strategy: Make the healthy choice the easy and cheap choice Combined this with campaigns and individual counselling for high risk individual No strategy can do it alone We need to change the default of dietary habits