Diet-dependent diseases

Transcription

1 Diet-dependent diseases Attila Tóth, PhD. Institute of Cardiology, Division of Clinical Physiology 2005 Noncommunicable diseases and nutrition I. - The growing epidemic of chronic disease affecting both developed and developing countries is related to dietary and lifestyle changes - There are significant negative consequences of inappropiate dietary patterns, decreased physical activities and increased tobacco use and a corresponding increase in diet-related chronic diseases, especially among poor people. - Alterations in diet have strong effects, both positive and negative, on health throughout life. Most importantly, dietary adjustments may not only influence present health, but may determine whether or not an individual will develop such diseases as cancer, cardiovascular diseas and diabetes much later in life. Noncommunicable diseases and nutrition II. - Chronic diseases considered in this lecture are those that are related to diet and nutrition and present the greatest public health burden either in terms of direct cost to society and government, or in terms of disability adjusted life years (DALYs). These include obesity, diabetes, cardiovascular diseases, cancer, osteoporosis and dental diseases. - Statistics: -In 2001 chronic diseases contributed approximately -60% of total deaths (56,5 million). -46% of global burden of disease. -It is projected that in 2020 these chronic diseases will contribute to : -75% of global deaths -57% of global burden of disease. 1

2 Main causes of death in Hungary total cardiovascular diseases Number of death Number of deaths Year Total Cancer Cardiological diseases 0 Stroke Atherosclerosis Pulmonary diseases Hepatological diseases accidents suicide Noncommunicable diseases and nutrition III. - Modern dietary patterns and physical activity patterns are risk behaviours that travel across countries and are transferable from one population (nation) to another like an infectious disease, affecting disease patterns globally. - While age and genetic susceptibility are non-modifiable, many risks associated with noncommunicable disease are modifiable. These include behavioural factors (e.g. diet, physical activity, tobacco use, alcohol consumption); biological factors (e.g. dyslipidemia, hypertension, overweight, hyperinsulinaemia); and societal factors. - The combination of these and other risk factors, such as tobacco use, is likely to have an additive or even multiplier effect, capable of accelerating the pace at which the chronic disease epidemic is emerging in the developing countries. The double burden of diseases in the developing world I. - Nearly 30% of humanity are currently suffering from one or more of the multiple forms of malnutrition. - The tragic consequences of malnutrition include death, disability, stunted mental and physical growth, and as a result, retarded national socioeconomical development. Some of 60% of the 10.9 million deaths each year among children aged under five years in the developing world are associated with malnutrition. - Iodine deficiency is the greatest single preventable cause of brain damage and mental retardation worldwide, and is estimated to affect more, than 700 million people, most of them located in the less developed countries. - Over 200 million people have iron deficiency anaemia - Vitamin A deficiency is the single greatest preventable cause of needless childhood blindness and increased risk of premature childhood mortality from infectious diseases, with 250 million children under five years of age suffering from subclinical deficiency. 2

3 The double burden of diseases in the developing world II. - Intrauterine growth retardation, defined as birth weight below the 10 th percentile of the birth-weight-for-gestational-age reference curve, affects 23.8% or approximately 30 million newborn babies per year, profoundly influencing growth, survival, and physical and mental capacity in childhood. - It also has a major public health implications in view of the increased risk of developing diet-dependent chronic diseases later in life. - In the past, undernutrition and chronic diseases were seen as two totally separate problems, despite being present simultaneously Diet, nutrition and preventable chronic diseases I. - Fetal developement and the maternal environment -Intrauterine growth retardation: associated with an increased risk of cardiovascular disease, stroke, diabetes and rised blood pressure. -Higher birth weight is related to increased risk of diabetes, cardiovascular disease, breast and other types of cancer. - Infancy -An association between low growth in early infancy (low weight at 1 year) and an increased risk of cardiovascular disease has been described. -The risk of stroke and also of cancer mortality (e.g. breats, uterus, colon) is increased if shorter children display an accelarated growth in height -Brestfeedinding is associated with lower blood pressure levels in childhood -Lower risk of developing obesity is directly related to lenght of exclusive breastfeeding. -The risk of chronic diseases of childhood and adolescence (e.g. type 1 diabetes, coeliac disease, some childhood cancers, inflammatory bowel disease) have also been associated with infant feeding on breast-milk substituents and shortterm breatsfeeding. -Increased atherosclerotic lesions associated with increased levels of plasma total cholesterol were related to increased dietary cholesterol in early life Diet, nutrition and preventable chronic diseases II. - Childhood and adolescence: -An association between low growth in childhood and an increased risk of chronic heart disease has been described, irrespective of size at birth. -There is a significant positive relationship between childhood energy intake and adult cancer mortality. -There is relationship between onset of of obesity and cancer risk. -There is a higher prevalence of raised blood pressure not only in adults of low socioeconomical status, but also in children from low socioeconimical backgrounds -Overwieght children wre 2.8 times as likely to became overweight adolescents -Conversely, underweight children were 3.6 times as likely to remain underweight as adolescents -Raised blood pressure, impaired glucose tolerance and dislypidaemia are associated in children and adolescents with unhealthy life styles. -Physical inactivity and smoking have found independently to predict cardiovascular disease and stroke in later life. 3

4 Diet, nutrition and preventable chronic diseases III. - Adulthood -There are firmly established associations between cardiovascular disease and tobacco use, obesity, physical inactivity, cholesterol, high blood pressure and alcohol consumption. -Other risk factors, recently recognized: high levels of homocysteine, the related factor of low folate and the role of iron. - Ageing, old people and patients suffering from disease -Higher need of nutrients and physical activity Diet, nutrition and preventable chronic diseases III. - Interactions between early and late factors throughout the life course -Clustering of risk factors -Intergenerational effects - Gene-nutrient interactions and genetic susceptibility - Intervening throughout life -Unhealthy diets, physical inactivity and smoking are risk factors for chronic diseases -Hypertension, obesity and lipidaemia are risk factors for cardiovascular disease, stroke and diabetes -Some of the risk factors are emerge and act in early life and have a negative impact throughout life course -Some preventive interventions early in the life course offer lifelong benefits -Improving diets and increasing level of physical activity in adults and older people will reduce chronic disease risks for death and disability -58% reduction in the risk of progression of diabetes over 4 years. -80% of cases of coronary heart disease and 90% of cases of type 2 diabetes could potentally be avoided Excess weight gain and obesity: strenght of evidence Regular physical activity High dietary intake of dietary fibre Environment which support healthy food choises Brestfeeding Low glycaemic index foods Increased eating frequency Sedatory life styles High intake of energy dense micronutrient poor foods Heavy marketing of fast food and energy dense food High intake of sugar sweetened drinks Adverse socioeconomic conditions Protein content of the diet Large portion sizes High proportion of food prepared outside the home Alcohol 4

5 Diabetes: strenght of evidence Voluntary weight loss in overweight and obese people Physical activity Excessive intake of nonstarch polysaccharides Overweight and obesity Abdominal obesity Physical inactivity Maternal diabetes Saturated fats Intrauterine growth retardation N-3 fatty acids Low glycaemic index foods Exclusive brestfeeding Vitamin E Chromium Magnesium Moderate alcohol Total fat intake Trans fatty acids Excess alcohol Cardiovascular diseases: strenght of evidence Regular physical activity Linoleic acid Fish and fish oils Vegetables and fruits Potassium Low or moderate alcohol intake Alpha-linoleic acid Oleic acid NSP Wholegrain cereals Nuts (unsalted!) Plant sterols Folate Flavonoids Soy products Calcium Magnesium Vitamin C Vitamin E supplements Stearic acid Overweight and obesity Myristic and palmitic acids High sodium intake High alcohol intake Dietary cholesterol Unfiltered boiled coffee Fats rich in lauric acid Impaired fetal nutrition Beta carotene supplement Carbohydrates Iron Cancer: strenght of evidence / insufficient Physical activity (colon) Fruits and vegetables (oral cavity, oesophagus, stomach, colorectum) Physical activity (breast) Fibre Soya Fish N-3 fatty acidc Carotenoids Vitamins B2, B6, folate, B12, C, D, E Calcium, zinc and selenium Non nutrient plant constituents (e.g. allium compounds, flavinoids, isoflavones, lignans) Overweight and obesity (oesophagus, colorectum, breast in postmenopausal women, endometrium, kidney) Alcohol (oral cavity, pharynx, larynx, oesophagus, liver, breast) Aflatoxin (liver) Chinese style salted fish (nasopharynx) Preserved meat (colorectum) Salt preserved foods and salt (stomach) Very hot (thermally) drinks and food (oral cavity, pharynx, oesophagus) Animal fats Heterocyclic amines Polycyclic aromatic hydrocharbons Nitrosamines 5

6 Dental diseases: strenght of evidence I. Diet and dental caries Fluoride exposure (local and systematic) Starch intake Amount of free sugars Frequency of free sugar intake Hard cheese Sugar-free chewing gum Whole fresh fruit Xylitol Milk Dietary fibre Undernutrition Dried fruits Dental diseases: strenght of evidence I. Diet and dental erosion Soft drinks and fruit juices Hard cheese Fluoride Whole fresh fruit Dental diseases: strenght of evidence I. Diet and enamel developmental effects Vitamin D Excess fluoride Hypocalcaemia 6

7 Dental diseases: strenght of evidence I. Diet and periodontal disease Good oral hygiene Deficiency of Vitamin C Undernutrition Antioxidant nutrients Vitamin E supplementation Sucrose Osteoporosis: strenght of evidence (older people) (older people) Vitamin D Calcium Physical activity Fluoride High alcohol intake Low body weight Fruits and vegetables Moderate alcohol intake Soy products Phosphorus High sodium intake Low protein intake High protein intake - Diet and physical activity are related Summary - Changes in life styles are not in accordance with requirements of the body - Most of the chronic diseases are proven to be affected by appropriate diet and physical activity - Diet is more important in case of pregnancy, young age, old age, diseased states - Diet is a modifiable risk factor - Overweight and obese have a greatly increased risk for multiple severe diseases and premature death Suggested text: Diet, nutrition and the prevention of chronic diseases, written by members of a joint WHO/FAO Expert Consultation, Geneva, (or 7