NEW CLINICAL GUIDELINES FOR THE MANAGEMENT OF OBESITY AND METABOLIC SYNDROME

Transcription

1 NEW CLINICAL GUIDELINES FOR THE MANAGEMENT OF OBESITY AND METABOLIC SYNDROME Alexander Frame, Richard Mathias School of Population and Public Health

2 Obesity Pandemic (WHO) Developed Nations Developing Nations Obesity and complications Type 2 Diabetes High cholesterol Hypertension Heart Attack Stroke Impotence Claudication double burden" of disease not uncommon to find under-nutrition and obesity existing side-byside

3 What is Causing Us to Gain Weight Behavioural Model? Decrease Activity Psychosocial stressors High TV viewing Genetics? Low SES? Calories IN Calories OUT

4 Epidemiological Study Mozaffarian et al. US Trends 2 Between 1965 and 2002 Positive association of weight gain with Refined sugars and starches Sugar-sweetened beverages Proportion of calories increased from 11.8% to 21.0% of all calories consumed Sleeping < 6 hours or > 8 hours Negative association of weight gain with Dairy products Unprocessed foods nuts, whole grains, fruits and vegetables Physical activity

5 Fructose Metabolism Fructose ATP & CO 2 Glycogen Triglycerides and Fatty Acids

6 Glucose Metabolism Glucose ATP & CO 2 Glycogen Triglycerides and Fatty Acids Low-fat eucaloric diet with a high sugar and/or starch content in normal weight individuals Stimulates liver lipogenesis & serum triglycerides

7 Carbohydrate Consumption If consume physiological doses of sugars Homeostasis is maintained Normal blood sugars Normal blood pressure Normal lipid profiles Advent of processed foods high in starch and beverages high in sugar Pharmacological doses of sugars Obesity pandemic

8 Connection between Obesity and Chronic diseases? Inflammation of adipose Insulin resistance Hyperinsulinemia Hunger Fatigued Exercise? Lipogenesis small LDLs & oxidized LDLs

9 Intervention Decrease sugars intake in the general population Dramatically reduce sugars in those with insulin resistance DM Prediabetes Dyslipidemia Metabolic syndrome Initially very low carbohydrate ketogenic diet Reducing sugar sweetened beverages is a great start

10 What do we replace the sugars with? Satiety Signal to brain (hypothalamus) Full Foods with most satiety Protein (20-30%) Fat Fiber Thick liquids Replacing sugars with fats is a necessary public health message to the public and to food producers.

11 What About the Message to Reduce Fat? Women s Health Initiative (WHI) Trial Over 8.1 years 19,000+ postmenopausal women (mean BMI = 29.1 kg/m2) Reduced total fat intake Moderately increased carbohydrates Fruits, vegetables and fiber No significant reduced risk for Stroke Cardiovascular Disease (CVD) Coronary Heart Disease (CHD) All cause mortality No decrease incidence of breast or colorectal cancer Conclude: Lower fat is not beneficial in reducing mortality risk

12 What About Saturated Fat? Siri-Tarino et al (2010) Meta-analysis of prospective cohort studies Intake of saturated fat No association with an increased risk of stroke, CVD and CHD Mente et al (2009) Systematic review Association between dietary factors and CHD No association with the consumption of saturated fat and eggs Strong evidence of an association with the consumption of trans-fatty acids foods with high glycemic index (GI) values western dietary pattern

13 Etiology of Obesity and Metabolic Syndrome Incomplete understanding of data on fat and sugar Needs to be changed

14 Public Health Message Reduce sugar consumption to as low as possible Replace those calories needed by the body with Fats Moderate increase in protein High fiber low sugar foods Most vegetables Fruits berries, avocado

15 Questions

16 Resources The New Atkins by Westman, Phinney and Volek The Art and Science of Low Carbohydrate Living by Phinney and Volek Why we get fat and what to do about it by G Taubes

17 References 1. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. New England Journal of Medicine. 2011;364(25): Malik VS, Popkin BM, Bray GA, Després J-P, Willett WC, Hu FB. Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes. Diabetes Care Nov 1;33(11): Kristensen M, Jensen MG. Dietary fibres in the regulation of appetite and food intake. Importance of viscosity. Appetite Feb;56(1): Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid food. Curr Opin Clin Nutr Metab Care Jul;14(4): Stanhope KL. Role of Fructose-Containing Sugars in the Epidemics of Obesity and Metabolic Syndrome. Annual Review of Medicine Feb 18;63(1): Nguyen S, Lustig RH. Just a spoonful of sugar helps the blood pressure go up. Expert Rev Cardiovasc Ther Nov;8(11): Cox CL, Stanhope KL, Schwarz JM, Graham JL, Hatcher B, Griffen SC, et al. Consumption of fructose-sweetened beverages for 10 weeks reduces net fat oxidation and energy expenditure in overweight/obese men and women. European Journal of Clinical Nutrition Sep 28;66(2): Volek JS, Phinney SD. The Art and Science of Low Carbohydrate Living. Beyond Obese, LLC; Hudgins LC, Baday A, Hellerstein MK, Parker TS, Levine DM, Seidman CE, et al. The effect of dietary carbohydrate on genes for fatty acid synthase and inflammatory cytokines in adipose tissues from lean and obese subjects. J. Nutr. Biochem Apr;19(4): Gutierrez DA, Puglisi MJ, Hasty AH. Impact of increased adipose tissue mass on inflammation, insulin resistance, and dyslipidemia. Current diabetes reports. 2009;9(1): Choi SH, Ginsberg HN. Increased very low density lipoprotein (VLDL) secretion, hepatic steatosis, and insulin resistance. Trends Endocrinol. Metab Sep;22(9): Howard BV, Van Horn L, Hsia J, Manson JE, Stefanick ML, Wassertheil-Smoller S, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA Feb 8;295(6): Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American journal of clinical nutrition. 2010;91(3): Howard BV, Curb JD, Eaton CB, Kooperberg C, Ockene J, Kostis JB, et al. Low-fat dietary pattern and lipoprotein risk factors: the Women s Health Initiative Dietary Modification Trial. Am. J. Clin. Nutr Apr;91(4):

18 Serum Total to HDL cholesterol after a dietary change Replace 10% of average US diet with listed food Mensink et al.

19 Food Choices Loss Weight Fiber foods Fat Proteins

20 Higher Fructose Consumption Associated with Hypertension Visceral adiposity Increased inflammation Decreased insulin sensitivity Increase liver lipogenesis and dyslipidemia Elevations in proatherogenic lipids - small LDLs and oxidized LDLs Consumption of fructose gone from physiologic to pharmacological doses

21 Want a Snack Say no to: Cookies Cake Crackers Ice-cream Chocolate bar Granola bar Candies Say yes to: Nuts 70% + Coco chocolate Dairy - Yogurt and cheese

22 Conclusion Gain Weight Potatoes Rice Pasta Bread Soda pop Juice/Fruit Drinks Candy/Chocolates Snacks (most)

23 Triglyceride s

24 Total Cholesterol-to-HDL Ratio = Total Cholesterol (VLDL, LDL, HDL)/HDL Chol

25 Bad Cholesterol

26 HDL-Cholesterol