Could plant-based eating meet all our nutritional needs...

Transcription

1 Associate Parliamentary Food and Health Forum Could plant-based eating meet all our nutritional needs... Dr. Janice Harland HARLANDHA ASSOCIATES

2 ...and, if so, should Government advice on healthy eating encourage more plant based eating?"

3 Principles adopted in reviewing evidence... Search conducted in Medline Search terms: plant-based all references Vegetarian + health issue, eg cholesterol, heart, BP, bone, weight etc Mediterranean Diet + health issue Hand search of references, reviews, meta analyses Total number of references: 900+ Primary source of data were studies conducted in humans Randomised controlled studies Observational studies: cohorts, longitudinal studies, case-controlled studies Data extracted and summarised in common format

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5 Summary outline What is plant-based eating Why encourage plant-based eating Nutrient Intake & Benefits Health Benefits Plant-based eating & government recommendations

6 A plant-based diet FRUITS AND VEGETABLES NUTS AND SEEDS WHOLEGRAINS PULSES INCLUDING SOYA

7 Spectrum of plant-based eating Plant-based meat eaters Pescetarians Ovovegetarians Lacto-ovo vegetarians Lactovegetarians Vegan

8 Key Nutritional and Dietary Recommendations and Achievements Nutrient Recommendation Current Intake* Recommendation Achieved? Total fat (% food < 35% 34.8% among energy) adults Saturated fat (% < 11% 12.8% among x food energy) adults Fibre g (NSP) 18g/ day 13.9g/ day in x adults Fruit and Vegetables At least 5 x 80g portions/ day 4.2 x 80g portions/ day in adults x Whole-grains 3+ portions/ day** < 1 portion/ day among adults*** x * National Diet and Nutrition Survey: headline results from years 1 and 2 combined (2008/ /10) ** US recommendations ** *Thane, C.W., et al., Br J Nutr, :

9 Men s Average Daily Intake of Selected Nutrients by Diets in the Oxford Arm of the EPIC study Meat Eaters Fish Eaters Vegetarians Vegans Energy (MJ) %e from total fat %e from saturated fat %e from PUFA NSP (g) Davey, G.K., et al. Public Health Nutr, (3): p

10 % with dietary intakes <LRNI Other aspects of health - nutrient density Percentage of women aged 19-64y with selected micro-nutrient intakes <LRNI None 1st 2nd 3rd 4th 5th Level of whole-grain intake Iron Calcium Zinc Ribo flavin Vitamin A (RE) None indicates no whole-grain intake/kg body weight/d (n=232), 1 st to 5 th (each n= ) indicates increasing fifths of whole- grain intake/kg body weight/ d. Source:MRC Human Nutrition Unit Janice Harland

11 Key Nutritional and Dietary Recommendations and Achievements Nutrient Recommendation Plant based diets Recommendation Achieved? Total fat (% food < 35% energy) Saturated fat (% < 11% food energy) Fibre g (NSP) 18g/ day Fruit and Vegetables Whole-grains At least 5 x 80g portions/ day 3+ portions/ day** * National Diet and Nutrition Survey: headline results from years 1 and 2 combined (2008/ /10) ** US recommendations

12 Food Intake vs Eatwell Plate 33% 33% 23% 25% 22% 15% 12% 8% 15% 15% Eatwell Plate (Recommended) WWF, Livewell: a balance of healthy and sustainable food choices. January Current UK Diet For Men and Women

13 Major Foods Contributing to Adults SFA Intake (NDNS 2008/ /10) Men 4% Meat and meat products Women 5% 18% 22% 27% Milk and milk products Cereals and cereal products 20% 22% 23% Butter National Diet and Nutrition Survey: headline results from years 1 and 2 combined (2008/ /10)

14 Summary Health Benefits CVD Weight Management Diabetes

15 Plant-based Eating & Cardiovascular Health Gardner study: 120 adults aged 30-65y Low fat (30%e) diet rich in vegetables (+7.6 servs), legumes, nuts and seeds (+3.7 servs),whole grains (+3.6 servs) & fruit (+0.8 servs). Source: Gardner, Ann Intern Med, :

16 Plant-based Eating & cardiovascular health Plant-based eating associated with healthier cholesterol levels and profile Clinical studies (3) indicate Total C 8-10% ; LDL-C 9-15% Portfolio diet studies (10+) >400 subjects; diets rich in soya protein, viscous fibres, tree nuts, plant sterols LDL-C: -20 to -35% (long term study -13%) (Jenkins) Observational studies (8+) data suggest risk of heart disease 20% Some indication of lower BP Studies indicate those consuming more plant foods have lower SFA intake, but also other components intrinsic to plants foods appear to be important Overall good evidence to support that plant-based eating promotes heart health

17 Plant-based Eating & weight control Sabate & Wien meta analysis: 36 vegetarian studies Vegetarians - adults & children have lower body weight -7.7kg (M) (P<0.0001) and 3.3kg (F) (P=0.007) Adventist studies indicate as people progress from vegan to mixed diet weight increases BMI Kg/m Sabate, J. and M. Wien, Am J Clin Nutr, : 1525S-1529S.

18 Plant-based Eating & weight control Oxford vegetarian study:1,914 M & 3,378 F BMI lower in vegetarians -1.1 kg/m 2 (M) (P<0.001) and 1.0 kg/m 2 (F) (P<0.001) Oxford EPIC vegetarian study:21,966 M & F Mean annual weight gain in: Vegans 303g (M) and 284g (F) vegans (P<0.05) Fish-eaters 338g both M & F (P<0.001) All 389g M and 398g (F) German vegetarian study:20,000 M & F Inverse relationship between BMI and vegetarianism EPIC PANACEA:10 countries: 373,803 M & F People with greater compliance to Mediterranean diet: Modest weight change over 5yrs kg/pa 10% less likely to become overweight or obese Appleby, P.N., et al., Int J Obes Relat Metab Disord, : Rosell, M., et al., Int J Obes (Lond), : Chang-Claude, J. and R. Frentzel-Beyme,. Int J Epidemiol, : Romaguera, D., et al., Am J Clin Nutr, :

19 Plant-based Eating & weight control Key causes of obesity are increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity (WHO). Plant-based eating associated with lower body weight and less weight gain over time Plant-based foods & eating patterns are typically low in SFA and high in unsaturated fats and fibre - important in control of body weight Specific components found intrinsically in plant foods may work together to help with appetite regulation and promoting satiety WHO guidelines promote healthy behaviours to encourage, motivate and enable individuals to lose weight by eating more fruit and vegetables, as well as nuts and whole grains Source: WHO, Global Strategy on Diet, Physical Activity and Health 2004; WHO Recommendations for preventing excess weight gain and obesity, p61-71 :

20 Plant-based Eating & managing blood glucose Largely observational data Systematic review of 12 cohort studies risk of developing diabetes 17% higher when comparing high v low meat intake Each 120g increase in red meat intake the risk of developing diabetes was 20% higher The effect of eating pattern on type 2 diabetes prevalence in Adventist II Health Study Source: Aune, D., G. et al. Diabetologia, : Trapp, C.B. and N.D. Barnard, Curr Diab Rep, :152-8

21 Plant-based Eating & healthy bones Evidence from Observational Studies Data from 9 observational studies subject to Bayesian-type meta analysis, 2749 subjects, 4 studies in white & 5 in Asian populations, 6 studies in lacto-ovovegetarians and 3 in vegans Overall BMD at lumbar spine was 2% lower in lacto-ovovegetarians than omnivores 4% lower in vegetarians 6% lower in vegans Effect of BMD at femoral neck similar in vegetarians, overall authors conclude these differences were not clinically significant. Dr Lanham-New reviewed this analysis confirming that vegetarianism is not a serious risk factor for osteoporotic fracture & also pointed out significant weakness of the analysis was due to no adjustment for body weight. Ho-Pham, Am J Clin Nutr, : Lanham-New,Am J Clin Nutr :910-1.

22 Plant-based Eating & healthy bones Plant-based eating supports normal bone growth and development throughout life provided a wide variety of plant foods are consumed Plant-based eating is associated with lifestyle factors known to be beneficial to bone health such as greater physical activity and a lower incidence of overweight and obesity WHO recommends greater fruit and vegetable consumption for bone health Specific plant foods such as soya may contain isoflavones that may help to reduce bone health in later life Choose where possible plant foods fortified with calcium Welch, A.A., et al., Br J Nutr, : Kohlenberg-Mueller, K. and L. Raschka, J Bone Miner Metab, : Ma, D.F., et al., Clin Nutr, :57-64.

23 International nutrition recommendations & Plant-based Eating World Health Organisation (WHO) 2002 World Health Organisation (WHO) 2004 World Cancer Research Fund (WCRF) 2007 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans 2010 American Dietetic Association 2009 Keeping Fit for Life - Emphasize healthy traditional vegetable and legume-based dishes; - Select nutrient-dense foods such as fish, lean meat, liver, eggs, soya products (e.g. tofu and tempeh) and low-fat dairy products, yeast-based products (e.g. spreads), fruits and vegetables, herbs and spices, whole-grain cereals, nuts and seeds; - Consume fat from whole foods such as nuts, seeds, beans, olives and fatty fish. Recommendations in the Global Strategy on Diet, Physical Activity and Health report included Increase the consumption of fruits and vegetables, and legumes, whole grains and nuts Basing our diets on plant foods (like vegetables, fruits, whole-grains, and pulses such as beans), which contain fibre and other nutrients, can reduce our risk of cancer. To reduce your cancer risk, eat no more than 500g (cooked weight) per week of red meats, like beef, pork and lamb, and avoid processed meats such as ham, bacon, salami, hot dogs and some sausages. Several distinct dietary patterns are associated with health benefits, including lower blood pressure and a reduced risk of cardiovascular disease (CVD) and total mortality. A common feature of these diets is an emphasis on plant foods The totality of evidence documenting a beneficial impact of plant-based dietary patterns on CVD risk is remarkable and worthy of recommendation. Appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases

24 Plant-based Eating & government recommendations Many recommendations focus on plant-based eating Clear health benefits Improved likelihood of achieving nutritional targets Can be achieved by explaining it s not about giving up meat but putting plant foods first... Recommendations could be highly practical, meatfree days, shopping tips, meal suggestions, advice for eating out...

25 Reshaping the Plate 2/3 (or more) Vegetables, whole-grains and pulses 1/3 (or less) animal foods

26 In Conclusion Plant-based eating: emphasizes plant foods (whole-grains, legumes including soya, fruit, vegetables, nuts and seeds) tends to result in a diet low in total fat and SFA, high in fibre and that includes a good level of unsaturated fats is associated with healthy hearts, healthier blood cholesterol, BP and 20% lower incidence of CHD lower body weights and with less weight gain over time better blood glucose management good bone health and some plant foods may help reduce bone loss in later life can be easily achieved in practice due to the wide variety of plant foods now available is cost effective, healthy and can meet the nutritional requirements throughout the lifecycle.

27 THANK YOU FOR YOUR ATTENTION ACKNOWLEDGEMENTS the help and support of my co-author Lynne Garton is gratefully acknowledged as is the support of the Alpro Foundation. Complimentary copies of The Plant-based Plan courtesy of the Alpro Foundation are available at the end of the meeting or from Amazon priced