Steering committee members: Prof. R. Uauy (Chair, President of International Union for Nutrition Scienc Prof. P. Puska (Co-chair, President elect of the World Heart Foundation) Prof. I. Elmadfa (President elect of the International Union for Nutrition Scienc Dr. H. Zevenbergen (Nutrition director, Unilever) Mrs. C. Diekman (Director of University Nutrition, Washington University, Prof. B. Koletzko (University of Munich, Germany)
Day 1 Time (hrs) 13.00-13.30 Registration participants Chair day 1: Mrs. C. Diekman 13.30-13.45 Prof. R. Uauy & Prof P. Puska - Welcome & objectives of the meeting 13.45-14.45 Prof. R. Uauy - Overview of recommendations and guidelines on fat quality of the diet to achieve optimal health 14.45-15.30 Dr. H. Zevenbergen Foods with a high fat quality are essential for healthy diets 15.30-16.00 Break 16.00-16.45 Dr. T. Acreman - Consumer perception and insights on fats and fatty acids: knowledge of fat quality of the diet 16.45-17.30 Prof. I. Elmadfa Dietary fat intake a global perspective 17.30-18.30 Prof. B. Koletzko (moderator) - Plenary discussion with speakers of the day 19.00-22.00 Dinner (Steering committee will prepare Summary Statement of first day) 22.00 Distribution draft Summary Statement of first day
Day 2 Time (hrs) 8.30-9.00 Prof. P. Puska Fat and heart disease Yes, we CAN make a change. The case of North Karelia, Finland Chair day 2: Prof. I. Elmadfa 9.00-9.30 Review of Summary Statement of first day 9.30-11.30 Break-out session Communication for change to come to Call to Action 11.30-12.30 Feedback from break-out session 12.30-13.00 Break (Steering committee will finalize Summary Statement) 13.00-13.30 Steering committee - Presentation of final summary Statement 13.30 Closure of meeting
Chair Ms. Connie Diekman opens the meeting
Prof. R. Uauy welcomes participants
Prof. R. Uauy Overview of recommendations and guidelines on fat quality of the diet to achieve optimal health Three key slides
Deaths attributable to 16 leading risk factors: all countries Blood pressure Tobacco Use Cholesterol Underweight Unsafe sex Fruit & vegetable High BMI Physical inactivity Alcohol Unsafe water, hygiene Indoor smoke/fuels Iron deficiency Urban air pollution Zinc deficiency Vitamin A deficiency Unsafe health 0 1000 2000 Adapted from World Health Report 2003 High mortality Developing countrie Low mortality Developing countrie Developed countries 3000 4000 5000 6000 7000 8000 Deaths (thousand)
Mechanisms by Which Dietary Fatty Acids Potentially Influence Risk of Coronary Heart Disease Effects on Lipoprotein and Cholesterol metabolism receptor systems, gene expression and regulation (LDL, HDL, Lp(a), TG) Prostanoids:(Eicosanoids and Docosanoids) related functions Inflammation/cytokines Blood pressure / arterial stiffness Thrombosis and thrombolytic mechanisms Oxidative stress and re-perfusion injury Endothelial function and adhesion molecules Cardiac Rhythm (arrhythmias) Insulin Sensitivity
WHO TRS 916 Report : strength of evidence on factors and risk of developing CVD Evidence Decreased risk No relationship Increased risk Convincing Regular physical activity Vitamin E Myristic and palmitic acids Linoleic acid 18:2n-6 Supplements 14:0 16:0 Fish and fish oils Trans fatty acids (EPA &DHA) High sodium intake Vegetables & fruits (including Overweight berries) High alcohol intake Potassium Low to moderate alcohol intake Probable α-linolenic acid 18:3 n-3 n Stearic acid Dietary cholesterol Oleic acid 18:1 n-9n 18:0 Unfiltered boiled coffee Fibre Nuts (unsalted) Plant sterols/stanols stanols Folate Possible Flavonoids Fats rich in lauric acid Soy products Impaired fetal nutrition Beta-carotene supplement TRS 916 WHO 2003
Dr. H. Zevenbergen Foods with a high fat quality are essential for healthy diets Three key slides
Main dietary sources of fat Major contributors to intake of saturated fat Dairy (cheese, butter, milk) Meat Baked goods and snacks Cooking fats Major contributors to intake of polyunsaturated fat Vegetable oils Margarines and mayonnaise Nuts and seeds
Margarines, mayonnaise and vegetable oils can play a significant role in achieving the recommended intake of the essential fat ALA 1.60 1.40 1.20 1.00 0.80 0.60 0.40 0.20 0.00 Alpha-linolenic acid content (g/100 kcal) Rapeseed oil Mayonnaise (80% fat) Walnuts Soybean oil Liquid margarine Mayonnaise light Margarine (soft, light) Avocado Olive oil Broccoli Spinach Margarine (60% fat, premium) Margarine (Heart Health) Salmon Butter Chicken Bananas Nuts, mixed dry roasted Mackerel
Butter and fats raise bad cholesterol (LDL) levels; soft margarines and mayonnaise don t Fat composition of foods influences their ability to lower or increase blood cholesterol: predicted effect of consumption of 20 g per day LDL-cholesterol (%) 6 5 4 3 2 1 0-1 -2-3 Vanaspati Butter Palm oil Soft premium margarine Heart health margarine Premium mayonnaise Canola oil Adapted from Mensink, Zock, Kester, Katan. Am J Clin Nutr 2003;77:1146-55.
Dr. T. Acreman Consumer perceptions and insights on fats and fatty acids: knowledge of fat quality of the diet Three key slides
What do consumers think are the elements of a balanced diet? Global average % Developed average % Emerging average % Vitamins 95 95 94 Proteins 93 93 93 Fibre 88 91 85 Minerals 84 89 79 Carbohydrates 78 78 79 Salt 42 40 43 Fat 41 47 35 Sugar 38 32 44 Alcohol 3 3 2 Vitamins, proteins, fibre, minerals and carbohydrates are elements of a balanced diet. Fats are not. Foods that are needed for a balanced diet Wave 2 Q - Thinking about the different things that foods contains, which of these do you think people need for a healthy balanced diet? [drive:directory path\filename.ppt 15 ]
Do consumers know what types of fat are good or bad? Developed Average Emerging Average Bad % Neither % Good % Don t know % Bad % Neither % Good % Don t know % Omega 3 3 3 77 17 2 4 63 31 Omega 6 6 4 53 37 2 2 38 57 Essential fats 15 5 56 24 5 4 16 76 Mono-unsaturated fats 26 6 33 34 9 5 9 76 Poly-unsaturated fats 28 7 40 25 12 7 10 72 Transfats 49 4 7 40 13 3 5 79 Saturated fats 67 6 9 17 30 7 10 54 In general, consumers knowledge is low. They only know that saturated fats are bad and omega 3 is good, but the latter are not seen as fats. Whether fats are good or bad for you - Wave 1 Q - Now please tell me if you think each of the following types of food or components of food are good or bad for you. Do you think... is good or bad for you? [drive:directory path\filename.ppt 16 ]
Where do consumers think they can find essential fats? Olive oil Salmon Avocados Walnuts Sunflower oil Seeds Sardines Soybean oil Rapeseed oil Cheese Butter Margarine Roasted chicken with skin Chocolate Mayonnaise Biscuits Bacon Cakes/pastries Global average % 32 31 29 28 24 24 24 22 20 16 11 9 8 8 7 6 5 5 Developed average % 33 31 26 29 24 22 23 25 19 12 10 7 9 5 6 4 6 4 Emerging average % 31 31 32 28 23 27 25 20 21 20 13 11 7 12 9 8 4 7 Consumers can identify products with a healthy image, but cannot identify sources rich in essential fats. Knowledge of foods providing Essential fats Wave 2 Q - Now thinking about FAT which of these foods do you think are among the main providers of FAT? Please click on all those you think apply. [drive:directory path\filename.ppt 17 ]
Prof. I. Elmadfa Dietary fat intake a global perspective Three key slides
18 16 14 12 10 8 6 4 2 0 International data on intake of saturated fatty acids (SFA) in adults as %energy (*poor quality studies; NZ data: >15 yrs) US 2005-2006 BR* 2002-2003 IN* 2006 SG 2004 AU 1995-1996 NZ 1996-1997 AT 2004-2005 BE 2004 BG 1997 DK 1995 FI 2001 FR 2004 HU 1992-1994 IT 1994-1996 NL 1998 SE 1998 UK 2001 CA 2004 SFA %E
International data on intake of polyunsaturated fatty acids (PUFA) in adults as %energy (*poor quality studies; NZ data: >15 yrs) 12 10 8 6 PUFA %E 4 2 0 CA 2004 US 2005-2006 BR* 2002-2003 IN* 2006 SG 2004 AU 1995-1996 NZ 1996-1997 AT 2004-2005 BE 2004 BG 1997 DK 1995 FI 2001 FR 2004 HU 1992-1994 IT 1994-1996 NL 1998 SE 1998 UK 2001
International data on intake of unsaturated fatty acids (UFA) in adults as %energy (*poor quality studies; NZ data: >15 yrs) 25 20 15 UFA %E 10 5 0 UK 2001 CA 2004 US 2005-2006 BR* 2002-2003 IN* 2006 SG 2004 AU 1995-1996 NZ 1996-1997 AT 2004-2005 BE 2004 BG 1997 DK 1995 FI 2001 FR 2004 HU 1992-1994 IT 1994-1996 NL 1998 SE 1998
Prof. B. Koletzko Panel discussion with speakers of the day
Prof. P. Puska Change in the fat quality of the diet can be made: the example of the North Karelia study, Finland Three key slides
CHD Mortality in All Finland and in North Karelia, Men Aged 35-64 Per 100 000 700 start of the North Karelia Project extension of the Project nationally 600 500 400 North Karelia 300 200 100 All Finland - 80% - 85% 0 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 Source: Statistics Finland Year
Observed and Predicted Declines in Coronary Mortality in Eastern Finland, Men 0-10 -20-30 -40-50 -60-70 -80-90 % 1972 1977 1982 1987 1992 1997 2002 2007 Year Observed Predicted Cholesterol Blood pressure Smoking
Finland Has Shown: a change can be made Prevention of cardiovascular diseases is possible and pays off Population based prevention is the most cost effective and sustainable public health approach to CVD control Prevention calls for simple changes in some lifestyles (individual, family, community, national and global level action) Influencing diet and especially quality of fat is a key issue Many results of prevention occur surprisingly quickly (CVD, diabetes) and also at relatively late age Comprehensive action, broad collaboration with dedicated leadership and strong government policy support
Review of summary statement
Highlights of summary statement (I) In line with authoritative international health bodies and current evidence, the following recommendations on the quality of fat in the diet are made for optimal health across the life course worldwide, from an age of about two years onwards: - Fat may provide up to 30-35% of the daily energy intake; - Saturated fat should provide no more than 10% of the daily energy intake; - Essential polyunsaturated fats (omega 6 and omega 3) should contribute 6-10 % of the daily energy intake; - The intake of trans fats should be less than 1% of the daily energy intake; - The remainder of the energy from fat can be provided by monounsaturated fats.
Highlights of summary statement (II) -People should be advised how to decrease their saturated fat intake and increase the proportion of unsaturated and essential polyunsaturated fats and oils in a practical, sustainable and actionable way in order to be healthy today and tomorrow. - One of the most effective options is the provision of concrete examples of replacing foods in a diet generally high in saturated and trans fats (e.g. butter, fatty cheeses, fatty meats, products fried in unhealthy fats) with products with lower content of saturated and trans fats, and preferably use of foods high in unsaturated and essential polyunsaturated fats (e.g. sunflower oil, soybean oil, rapeseed oil, olive oil and products made from these such as soft margarines and mayonnaise).
Highlights of summary statement (III) -An additional option is to provide people with important information on the content of food products on-pack in a clear, usable, understandable way, including energy content per portion size and fat quality. -Use simple language when communicating with the public, e.g. good/healthy fats and bad/unhealthy fats and use consistent, scientific and coherent language when communicating with health experts. - The food and food service industry should collaborate with health and nutrition experts to ensure appropriate messaging based on current recommendations, to eliminate trans, reduce saturated fats and provide accurate information to enable people to make healthier choices.
Highlights of summary statement (IV) -Nutrition and health experts should provide consistent evidencebased information supporting public health goals and become nutrition communicators. They also should continue to seek collaboration with the food industry, governments and NGOs. -Health care professionals should take responsibility for ensuring that patients receive the right information and support on current dietary recommendations. They should provide their patients with advice on selection of dietary fats as they do on other preventive actions and if necessary, seek training to be able to provide proper advice or to refer them to nutrition specialists.
Highlights of summary statement (V) The International Expert Meeting calls on scientists, health care professionals, governments, food industry, health authorities and media around the world to advocate consistent, simple and effective messages to improve the fat quality of the diet of people everywhere and promote such changes for the prevention of chronic disease and to achieve optimal health.
Signing of the summary statement