New Era s Health Challenges and Nutrition Opportunities in China. Wenhua Ling, MD, Ph.D

Transcription

1 New Era s Health Challenges and Nutrition Opportunities in China Wenhua Ling, MD, Ph.D

2 Outline Ⅰ. Nutrition Status and Nutrition Problems in China II. Chinese dietary reference intakes Nutrients Non-nutrients and phytochemicals III. Nutrition and chronic metabolic diseases Cohort studies Achievements

3 Ⅰ. Nutrition Status and Nutrition Problems in China from National Nutrition Survey conduced in 1982, 1992,2002, and 2012 Food Consumption Nutrient Intake Nutrition Problems Nutrition related health problems

4 Study population of nutrition survey of Participants 210,000 people. A total of 31 provinces, autonomies, cities. Urban: Metropolis, moderate, and small cities. Rural:Ordinary and poor areas.

5 A total of 150 surveilliance spots: 34 metropolis ( ), 41 moderate and small cities ( ), 45 ordinary rural areas ( ) and 30 poor rural areas

6 Cereal and vegetable intake 1. Cereal consumption 2. Vegetable consumption consumption(g) Urban Rural Vegeable Consumption (g) Urban Rural The average cereal consumption The average vegetable consumption

7 3. Meat consumption 4. Milk consumption meat consumption(g) Urban Meat 1982 and milk intake Rural milk consumption (g) Urban Rural It is very imbalance between urban residents and rural residents.

8 5. Egg and egg product consumption 6. Oil consumption egg consumption (g) oil consumption (g) Urban Rural 0 Urban Rural

9 7. Salt consumption salt consumption (g) Urban Rural

10 Energy and nutrient intake

11 Energy intake energy intake (Kcal) total Urban Rural The average energy intake is kcal per reference man per day, accounting for 94% of the Reference Nutrient Intake.

12 Protein intake protein intake (g) total Urban Rural Fat intake The average protein intake was 64.6 g in The different between urban and rural areas was 1.7g in fat intake (g) total Urban Rural The average fat intake was 75.4g in The intake of urban residents was 12.7g more than that of rural residents in 2012.

13 Energy sources( ) porpotion (%) Urban Rural Total Fat Protein CHO Dietary fat provided 31.5% of energy intake. In the urban area it provided 35.5% of energy intake, that exceed the reference value (30%).

14 Vitamin intake vitamin Retinol (RE/d) retinol Equivalent (RE/d) Thiamine (mg/d) Riboflavin (mg/d) Ascorbic acid (mg/d) Urban Rural Total Thiamine and ascorbic acid intake was 0.9 mg and 80.5 mg. The intake of Thiamine and ascorbic acid has continuously dropped since The riboflavin intake has not been changed much in these years. The average intake was 0.8 mg, accounting for 62.9% of the RNI

15 Minerals---Iron Minerals--- Calcium iron intake (mg) total Urban Rural calcium (mg) total Urban Rural Compared with RNI in China, the intake of calcium are far below and almost equals to half of RNI.

16 Nutrition-related health problems

17 Anemia morbidity of anemia (%) Urban Rural Compared to the survey of 2002, the prevalence of anemia in urban residents reduced by 46.7%,in rural residents reduced by 53.4%.

18 Overweight & Obesity(2002) Rate (%) overweight obesity 0-6 Years 7-17 Years 18- Years total Overweight & Obesity( ) Years Rate (%) Years 0 overweight obesity

19 Hypertension 14.5% 18.8% 22.8% Diabetes The prevalence of hypertension among adults was 22.8% in Prevalence Rate (%) Age Group The prevalence of diabetes among adults was 6.8% and 14.7% in 2002 and This means there are more than 80 million diabetic patients in China.

20 Blood Lipid Abnormality (>18y) Prevanlence Rate (%) urban large city small-medium city Prevanlence Rate (%) male female Age Group

21 Existing Nutrition Problems in China In large and medium sized cities in China, the number of people with nutrition-related diseases is increasing annually.

22 II. Chinese dietary reference intakes Nutrients for DRIs We are integrating food and nutrition disciplines in nutrition and food sciences to accelerate the research Setting new DRIs 2000 Chinese Dietary Reference Intakes 2013 Chinese Dietary Reference Intakes

23 Chinese Dietary Reference Intakes--DRIs Estimated average requirement (EARs) Recommended nutrient intake (RNI), equal to RDA Adequate intake (AIs) Tolerable Upper Intake level (UL) Acceptable macro-nutrient distribution ranges (AMDR) 23

24 General situation for DRIS of 2013 Set new quantitative value for RNI, AI and UL Acceptable macro-nutrient distribution ranges (AMDR) Proposed intakes for preventing non-communicable chronic diseases (PI-NCD) Afford systematical review for the components

25 Introduction Macronutrient fat-soluble vitamins 4 water -soluble vitamins 10 Trace Elements 10 Macro-elements 6 Definition,methods, formula, application E, CHO, Fat, and fat acids: DHA, EPA, n-3 Protein Vit A, Vit E Vit D, Vit K VitB1, B2, B6, B12, Folic acid, Vit C, Niacin,Choline, Biotin, Pantothenic acid Zinc, Iron, I, se, cobalt Cu, Mn, Mo, Cr, F Ca, P, Mg, K, Na, chloride Non-nutrients 21 Water, Fiber 18 Phytochemicals

26 Non-nutrients and phytochemicals Set SPL for bioactive compounds Recent experiences in China

27 What is SPL? SPL= Specific Proposed Levels SPL and UL are a comprehensive set of values for phytochemical in healthy populations that can be used as a guide for their diet. SPL reflect the current scientific knowledge regarding to nonnutrients. Daily intake up to this level is beneficial to human health.

28 non-nutrients substances reviewed list water Dietary fiber FOS anthhoyanin Resveratrol Catechol Quercetin Curcumin Chlorogenic acid Lutin Zeaxanthin Lycopene Proanthocyanidins Isoflavones Phytosterol Isothiocyanates Allicin, Garlic, Glucosamine GABA alpha-lipoic Acid (LA) L-carnitine

29 Specific Proposed Level (SPL) Group A : Setting AI 2 Group B Setting SPL 9 Group C : data insufficient 11 Informative insufficient Water L Soy lsoflavone 55 mg L-carnitine Fiber g Lutin 10 mg Resveratrol Lycopene 20 mg/d r-gaba phytosterol 0.9/d, 1.5g/d curcumin Glucosamine 1g/d, 1.5g Allicin Anthocyanin 50mg/d Chlorogenic acid Quercetin 12mg alpha-lipoic Acid catechins Isothiocyanates Proanthocyanin FOS 29

30 UL: recommended Group A: 5 Not necessary. Water catechins r-gaba anthocyanin Taurine Group B: 9 UL Xanthophylls 40mg/d Lycopene 70mg/d lipoic acid 600mg/d Curcumin 180 mg/d Resveratrol 2.5g/d Proanthocyanin 800mg/d Phytosterol 2.4g-3.9g/d Soy lsoflavones 120mg/d L- carnitine 75mg/d Group C: 5 Informative insufficient Allicin Glucosamine DF Isothiocyanates Quercetin Fructoligosaccharide Chlorogenic acid

31 III. Nutrition and chronic metabolic diseases in China Prospective cohort study Nutrients related risk factor of chronic diseases Provide adequate food, dietary pattern, nutrients.

32 Cohorts on nutrition, health and chronic diseases Cohort name Subjects Period Principal Investigator Chinese chronic disease cohort 500,000 subjects from present Li, liming Jiaxing Birth Cohort 42,550 children from present Li, Duo CHD patient cohort 5,000 patients from present The Harbin Cohort Study on Diet, Nutrition and Chronic Non-communicable Diseases Ling, Wenhua 9734 people Sun, Changhao

33 Food and nutrients affect chronic diseases Diets and Nutrients Phytochemicals Animals Human trials In vitro Chronic diseases Effects and mechanisms

34 Food and Nutrients affect chronic diseases Biology age gender gene Social and Environments Physical Smoke diet Biomarkers Inflammation Oxidative stress dyslipidemia Abnormal glucose metabolism Mutated genes Clinical outcomes CHD Hypertension Diabetes Obesity Cancers 34

35 Publications 1. Rong Y, Chen L, Zhu T, Song Y, Yu M, Shan Z, Sands A, Hu FB, Liu L*. Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort studies. BMJ Jan 7; 346: e8539. (IF: 16.25) 2. Yu Z, Ye X, Wang J, Qi Q, Franco OH, Rennie KL, Li H, Liu Y, Hu FB, Lin X*. Associations of physical activity with inflammatory factors, adipocytokines and metabolic syndrome in middle-aged and older Chinese people. Circulation. 119: , (IF:14.95) 3. Xia M, Liu Y, Guo H, Wang D, Wang Y, Ling W*. Retinol binding protein 4 stimulates hepatic SREBP-1 and increases lipogenesis through PGC-1beta- dependent pathway. Hepatology. 2013; 58(2): (IF: 12.0) 4. Wang D, Xia M, Yan X, Li D, Wang L, Xu Y, Jin T, Ling W*. Gut Microbiota Metabolism of Anthocyanin Promotes Reverse Cholesterol Transport in Mice Via Repressing mirna- 10b. Circ Res. 2012;111(8): (IF: 11.09) 5.Chen ML, Yi L, Jin X, Liang XY, Zhou Y, Zhang T, Xie Q, Zhou X, Chang H, Fu YJ, Zhu JD, Zhang QY, Mi MT*. Resveratrol attenuates vascular endothelial inflammation by inducing autophagy through the camp signaling pathway. Autophagy Dec;9(12): (IF: 11.42)

36 Proposed collaboration Nutrition and Chronic Diseases epidemiology, interventional trails Phytochemicals and health chronic diseases prevention bioavailability health products

37 谢谢各位!

38 Basic principles for setting DRIs of 2013 Evidence based nutrition systematical review and meta-analysis Randomized controlled trial, RCT cohort study case-control study views from experts basic experiments