Healthy eating for middle-years Professor Tom Sanders Nutritional Sciences Division.
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Transcript of Healthy eating for middle-years Professor Tom Sanders Nutritional Sciences Division.
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Healthy eating for middle-years
Professor Tom Sanders
Nutritional Sciences Division
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Major causes of premature death in middle-aged subjects• Smoking related illness
• Alcoholism
• Diet related disease – cardiovascular disease and type 2 diabetes
• Cancer
2
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Storing fat in the wrong place
Metabolic syndrome
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Coronary Heart DiseaseCoronary Heart Disease
Type 2Type 2DiabetesDiabetes
HighHighLDL-CLDL-C
MetabolicMetabolicSyndromeSyndrome
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Relative Risk of Diabeteswith increasing BMI
05
1015202530354045
<23 23-24.9 25-29.9 30-34.9 >35
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What is driving obesity
Decreased physical activity
Increased energy intake among the susceptible
Increased access to high energy density foods especially outside the home
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Effect of fat additions on energy density
0 50 100 150 200 250 300 350
kcal/100g
Boiled potato
French fries
Cod baked
Cod fried in batter
Boiled rice
Fried rice
Chicken
Chicken fried
Chapatis made without fat
Chapati made with fat
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SCRATCH COOKING
COMPONENT COOKING
READY MEALS
TAKE-AWAYSSNACKING
‘ON THE HOOF’
DELIVERY QSR RESTAURANT
High skill base, time consuming, “food”
focused
Convenient social
e.g. primary products, traditional grocery
e.g. prepared vegetables,
prepared meat/fish,
sauces, pizza
e.g. Sandwiches,
Sushi
© WorldpanelTM division of TNS 2003
Slow Food Fast Food
Physical inactivityPhysical activity
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What we know about obesity management• Calorie intake must be decreased
(no clear difference between fat and carbohydrate calories)
• Portion control is crucial
• Avoid temptation – “Willpower lasts 2 weeks and is soluble in alcohol”
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Fat patterning associated with metabolic syndrome
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Obesity and metabolic syndrome• Obesity contributes to causing
metabolic syndrome
• Physical activity is protective
• A diet high in rapidly absorbed carbohydrate (both starch and sugar) makes metabolic syndrome worse
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Healthy artery
Atherosclerosis (chronic)
Thrombosis
(acute)
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16
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Health Survey 2003 England & Wales
0
10
20
30
40
50
60
70
80
16-24 25-34 35-44 45-54 55-64 65-74 75+Age group
% w
ith h
yper
ten
sio
n
All
Treated
Untreated
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Dietary factors contributing to raised blood pressure• Overweight
• Excess alcohol intake
• Low intake of fruit and vegetables
• High salt intakes
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Dietary factors influence blood cholesterol• Overweight
• High intake of saturated fat
• Unfiltered or boiled coffee (usually not significant unless large amounts consumed
• Cholesterol in foods such as eggs (small effect)
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Iso et al. Circulation 2006;113:195-202.
Intake of long chain n-3 fatty acids in 41,578 Japanese men and women and risk of CHD over 10 years
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3.58 4.76 5.63 6.870.0
0.5
1.0
Albert et al. N Eng J Med 2002; 346:1113-8
% long-chain n-3 fatty acids in blood lipids
Rel
ativ
e ri
sk
Risk of sudden death adjusted for risk factors in men enrolled in the Physicians Health Study
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GISSI_HFLancet 2008 Editorial“A simple and safe treatment with n-3 PUFA can provide a small beneficial advantage in terms ofmortality and admission to hospital for cardiovascular reasons in patients with heart failure in a context of usualcare.
George Davey SmithLancet Jan 2009“A reasonable interpretation of the GISSI-HF trial would be that the modest estimated effect of fish oil requires replication.”
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UK government recommendation on intakes in relation to reducing risk of cardiovascular disease
Aim to consume two portions of fish per week one of which should be oily
Providing ~3g long-chain n-3 PUFA/week or 0.45g/d
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Effect on risk of CHD events of replacing 5% energy saturated fatty acids from pooled analysis of 11 cohort studies
Jakobsen M et al. Am J Clin Nutr 2009;89:1-8.
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Dietary advice to prevent heart disease
• Avoid overweight/obesity
• Replace sources of saturated fat with unsaturated fat (i.e. liquid oils for hard fats)
• Eat more fish especially oil fish and less fatty meat
• Cut down on salt
• Avoid excessive consumption of sugar sweetened drinks and alcohol
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21st November 2006: FDF GDA Briefing
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21st November 2006: FDF GDA Briefing
Cheddar
Reduced fat cheddar
A
B