The place of plant-based eating in dietary guidelines · % with average daily intakes below LRNI,...

Alpro Foundation student symposium ‐ Leeds March 15, 2017

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The place of plant-based eating in dietary guidelines The Eatwell Guide and beyond

Ayela SpiroSenior Nutrition Scientist Nutrition Science Manager

The Moment for Plant‐based eating is Now University of Leeds 15th March 2017

The bottom line

At least 80% of premature heart disease, strokes and type 2 diabetes and 40% of cancers could be prevented through healthy diet, along with regular physical activity and avoidance of tobacco.

WHO 2009


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Diet can help prevent cancer

There are around 163,000 cancer deaths in UK

450 deaths every day

Cancer Research UK 2017

Diet can help prevent CVD

BHF 2017


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Overweight and obesity among adultsHealth Survey for England 2012 to 2014 (three-year average)

5 Patterns and trends in adult obesity

Adult (aged 16+) overweight and obesity: BMI ≥ 25kg/m2

Almost 7 out of 10 men are overweight or obese (66.4%)

Almost 6 out of 10 women are overweight or obese (57.5%)

Healthy Diet: Lifecourse

Healthy diet important for health throughout the lifespan

• promotes the achievement of healthy pregnancy outcomes;

• supports normal growth, development and aging;

• helps maintain healthful body weight;

• reduces chronic disease risks;

Promotes overall health and well-being.

But how do we know what a healthy diet or healthy dietary patterns are?


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Why look at plant based dietary patterns?

Nutrients

Foods

Diets

Nutrient intake and

statusSupplement

studies

green leafy veg, wholegrains,

berries

Vitamin E, C, B12 and folate,

flavonoids, omega-3 fatty

acids

totality of diet may have synergistic and cumulative effects on health and disease

Back to basics: Understanding FBDG

Dietary Patterns

• Foods and drinks that make up dietary intake over time• A customary way of eating• The result of choices on many eating occasions over time, both at home and away

from home

• Consist of multiple + interacting food components

• Are more predictive of overall health status and disease risk than are the individual foods or nutrients consumed


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Healthy Dietary Pattern

• A combination of foods that’s linked to good health when eaten with regularity

• Consuming one helps a person:• Achieve and maintain a healthy body weight• Obtain adequate nutrients• Reduce risk of chronic disease

• Can be tailored to meet an individual’s:• Personal, cultural and traditional preferences• Budget

Defining a healthy dietary pattern for the UK

Largely plant-based

How did we get here?

PHE 2016


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Food based dietary guidelines (FBDG)

Turn evidence-based scientific knowledge and government recommendations on foods, nutrients and health

into

Simple messages to help consumers make informed choices about the foods, drinks and dietary patterns that promote good health.

What are the Government recommendations?

Nutrient ‐ based

CHO ̃ 50% dietary E

Population average

Free sugars

≤5% dietary E Population average

Fat ≤ 35% dietary E

Population average

Sat fat ≤ 11% dietary E

Population average

Salt ≤ 6g Population average

Fibre ≥30g AOAC Population average

High intakes Energy intake

(obesity)

High intakesHigh BP

Food‐based

F & V ≥ 5 a Day Population average

Fish ≥ 2 a week (2 x 140g), 1 oily

Individual target

Red/ Processed meat

≤ 70g / d Individual targetHigh intake

Cholesterol

High intakesColorectal cancer

High intakesCVD

& colorectal cancer


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How is this translated to segments of Eatwell Guide?

Optimisation modelling

Optimisation modelling

• Computerised way of finding a combination of foods that meets all the nutrient recommendations while at the same time being closest to current dietary

• Utilised the most recent intakes of commonly consumed foods in the UK (NDNS 2008/9 – 20011/12 n= 1491, 56% woman)

• Most recent data on food composition

• Applying the revised government macronutrient and food recommendations (post SACN) for adults

• Looking at the fewest possible changes needed to achieve these.

• Mean consumption of food are altered such that

• adult dietary recommendations for foods and nutrients are achieved

• but deviates as little from current diet as little as possible

Scarborough et al 2016


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39%

37%

4%From32%

From 31%

Eatwell segment angles

What’s happened with protein food section?

• The name of food group ‘Beans, pulses, fish, eggs, meat and other proteins’ updated to place emphasis on certain food products that can be considered more environmentally sustainable.

• The change of name highlights the importance of plant-based proteins in a sustainable, healthy diet.

Eat more beans and

pulses


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Is UK alone in promoting plant based FBDG?

Where are these FBDG from?(Note proportion of plant-based foods)


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Even in France!


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Healthy patterns aligned

Healthy eating guidelines (FBDG) OR Plant-based diets OR Mediterranean diet, can be classified as ‘healthy’ eating patterns

In research, these patterns are typically defined using a priori defined scores (HEI, DASH or Medi Score) or a statistical analysis of certain components

Healthy pattern’ typically characterised by • higher consumption of vegetables, fruit, wholegrains, low fat dairy, seafood, nuts, seeds,

legumes • lower intakes of fatty/processed meat, refined grains, sugars-sweetened foods & drinks,

lower salt, lower saturated fat

Observational studies that look at ‘healthy’ vs less healthy dietary patterns show consistent evidence of decreased disease risk

Advisory Report DGAC 2015

But healthy patterns also associated with other lifestyle and socioeconomic factors


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Consistent patterns for health

• Examination of association between dietary patterns and health outcomes revealed consistency

• BUT allows great variety in the individual foods that people can eat to achieve better health

• “One size doesn’t fit all”

• Fit with cultural, religious, preferences – no need to give up food groups!

Fruit & Veg

Pulses/nuts/seeds

Wholegrains

Fish

High ratio PUFA/MUFA: SFA

Meat

Added sugars

Salt

Sat Fat

Excess Alcohol

UK Healthy Eating

MeDi

Nordic

OtherFBDG


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WCRF Cancer Prevention Recommendations

Translated to disease prevention advice

What changes would we need to make from current diet to meet our FBDG?


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Carbohydrates ≥50% of dietary energy 48.5%

Free Sugars ≤5% dietary energy 11.7% (NMES)

Fat ≤35% dietary energy 34.2%

Saturated Fat ≤11% ≤dietary energy 12.7

Fibre (AOAC) ≥30 g/d 18.6g

Salt ≤6g/d 8.0g

Fruits and Vegetables ≥ 5 portions of a variety each day 27%

UK diet compared with recommendations

Bates et al. 2016

Increase in wholegrain/high fibre CHO

• Increase in potatoes, rice, pasta and other starchy carbohydrates

• Particularly increase in wholemeal bread, potatoes and high fibre breakfast cereals

• Current 27.2, to new 36.7%



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Increase in fruit & veg

• Increase in fruit and veg (incl dried fruit)

• From current 28.8% to new 39.3%

• 342 to 526g/d (over 6 portions a day)

• But decrease in fruit juice


Meeting fibre recommendations


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Change in protein intake

• Decrease in meat (red, processed and white)

• Increase in oily and white fish

• Increase in beans, pulses and legumes

Current 14g/d to 26g/d


Other changes from current intake

Decrease in dairy (particularly cheese)

Decrease in sugars sweetened beverages, cakes, biscuits, confectionary

• Are all these changes acceptable to UK population?

• Model is based on average population data -a composite diet that is not consumed by anybody

• Optimisation cannot account for human behaviour!


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Micronutrient quality

% with average daily intakes below LRNI, by age and sex

Bates et al. 2016

Comparison to current diet

In addition, modelling does not account for differences in the

bioavailability of nutrientFurther work should explore this

Of 15 nutrients: • 11 would increase, incl. n-3 fatty acids, iron, folate, potassium, vitamins C, D and E • 4 would decrease (but less than 1%) – but mean intake Zn would fall below RNI



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Healthy and sustainable!• Eatwell guide – Estimated to reduce GGE, water and

land use

• DGAC - a dietary pattern that is higher in plant-based foods, and lower in animal-based foods is more health promoting and is associated with lesser environmental impact than is the current average U.S. diet.

• Sweden - Find your way to eat greener, not too much and to be active - eat healthily and in an environmentally friendly manner.

• Germany - Choose mainly plant-based foods. They have a health-promoting effect and foster a sustainable diet.

Final remarks

• Evidence on relationship between health and diet is used to set out food based guidelines

• Eatwell Guide is a pictorial representation of UK dietary recommendations, which have been set by SACN and COMA, including recent recommendations on reductions in free sugars and increase in fibre

• Eatwell Guide similar to other FBDG in that it is encourages a largely plant based diet

• UK population needs to change dietary patterns – this is a challenge!


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For further information, go to: www.nutrition.org.uk

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AcknowledgementMany thanks to University of Leeds for hosting and the Alpro Foundation for inviting me to present

The place of plant-based eating in dietary guidelines · % with average daily intakes below LRNI,...

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