Healthy Nutrition & Life style Let us start at the beginning!

Transcription

1 Faculty of Science Departement Pharmaceutical Sciences Healthy Nutrition & Life style Let us start at the beginning! Irene LENOIR-WIJNKOOP Disclosures Director Public Health & Scientific Relations, Danone Company Chair of INPHORM, a working group of Health Technology Assessment international (HTAi) Member of the Standing Committee Nutrition & Health, International Dairy Federation (IDF) IDF ILSI Liaison Officer ILW HTAI Oslo

2 Introduction Let medicine be thy food, and food be thy medicine. Hippocrates, BC Public Health: The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals Science 51 (1306):23-33 PH aims to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases WHO ILW HTAi Oslo ! ILW HTAi Oslo

3 Nutrition and the prevention of chronic diseases Although nutrient deficiency diseases are still prevalent in some countries, and are an important cause of ill-health and premature death, nutrient-associated chronic diseases due to incorrect balance or an excess of nutrients are now of significant importance in virtually all countries, developing and developed alike. Factors needed for successful nutrition and food policies: Food and nutrition policies must have the credibility provided by scientific and epidemiological evidence, have political and technical support, and be regarded as necessary and convenient by the consumer. ILW HTAi Oslo

4 The 21 st century epidemic? Many major health concerns are attributable to overweight and obesity directly affect metabolic health, CV health, body defences against cancers, respiratory functions, musculoskeletal functions, mental functions, fertility, In 2014, 39% of adults aged 18 years and over (38% of men and 40% of women) were overweight. In 2013, 42 million children under the age of 5 were overweight or obese. In developing countries with emerging economies the rate of increase of childhood overweight and obesity has been more than 30% higher than that of developed countries 25 years have passed, what next? ILW - 6 HTAi augustus Oslo Prevention is KEY, but The prevention of diet-related chronic diseases requires - Behavioural change, e.g., in diet, exercise and life style BUT - A greater the consumers sense of responsibility for their own health BUT - A broad yet well circumscribed approach allowing measurable (health & costs) outcomes BUT - Insight on the ratio between investment/resulting gain BUT ILW - 6 HTAi augustus Oslo

5 An ideal target Citizens who - have a particular motivation/willingness to act - are receptive to educational counselling - are in a condition that allows/ facilitates regular monitoring An intervention which - allows to observe some immediate results without adding much infrastructure to the existing - will contribute to stabilise the NCD epidemic; or even bend the curve - offers a setting for follow-up assessments over the years Shutterstock Prepregnancy & maternal overweight/ obesity results in similar conditions in the next generation and a vicious circle is thus triggered (DOHad) ILW - 6 HTAi augustus Oslo Developmental Origins of Health and Disease (DOHaD) The health of the mother, before and during pregnancy and growth during fetal and early postnatal life determine the structure, function and adaptive capacities of the key organs. Together these define the capability of an individual to interact with its environment UN position paper 2011, P. James Vickers. Ann Nutr Metab 2014 ILW - 6 HTAi augustus Oslo

6 Hyperglycemia in pregnancy (20-49 years) by IDF regions, % cases are in low middle income countries 17,5 14,4 12,6 10,4 11,4 11,9 Africa Europe Middle East & North Africa North America & Caribbean South & Central Africa South East Asia Western pacific ILW HTAi Oslo LGA by BMI, GDM and GWG at weeks Kim et al. Obstet Gynecol 2014 ILW - 6 HTAi augustus Oslo

7 Maternal BMI & LGA, macrosomia and related outcomes in offspring Birth Weight Grade Risks g I Mother+ newborn (induction of labour, caesarean delivery, and birth injuries) GWG modifies the association between maternal prepregnancy BMI and childhood adiposity-related measurements g II Neonatal morbidity (5-min Apgar <3, meconium aspiration, and greater risk of lung immaturity) > 5000 g III Birth trauma and death Boulet et al. Am J Obstet Gynecol 2003 Risk of fœtal macrosomia by maternal BMI category and GDM status Martin et al. Diab Res & Clin Practice 2015 Kaar et al. J Pediatrics 2014 ILW - 6 HTAi augustus Oslo A vicious circle for later life and the future generations Prevalence of MS according to birth weight and maternal diabetes. Boney 2005 Drake et al. Trends in Endocrinology and Metabolism 2010 (at birth) Cnattingius et al. Int J Obesity 2012 ILW - 6 HTAi augustus Oslo

8 Encourage investment on the long term Assesment of healthcare expenditures and HRQL during pregnancy and the perinatal period would to ensure sustainability of the intervention(s) High birth weight is associated with maternal complications A recent pilot evaluation confirms the potential of showing considerable cost savings on a short term Average of total additional costs per pregnancy/delivery - Overweight= US$ Mother = US$ Macrosomic newborn = US$ Stotland et al. Int Gynecol Obstet GDM women = US$ Mother = US$ Macrosomic newborn = US$ A recent literature review indicates an extra lifetime medical cost of $19,000 for the obese child compared to a normal weight child, in the USA Finkelstein et al. Pediatrics 2014 Lenoir-Wijnkoop et al. Frontiers in Pharmacology 2015 ILW HTAi Oslo Empower women of childbearing age to prepare a healthy future ILW - 6 augustus

9 Will HTA be able to bridge the gap & turn a vicious circle into a virtuous one? ILW HTAi Oslo