Diet ,Nutrition & Life long Health: New opportunities for agriculture

1. inta IUNS UNU Diet ,Nutrition & Life long Health: New opportunities for agriculture Ricardo Uauy MD PhD London School of Hygiene and Tropical Medicine University of London www.lshtm.ac.ukand Institute of Nutrition University of Chile www.inta.cl

2. 100 75 50 25 0 inta Improvements in Life Expectancy Ideal 2000 1965 Future? 1930 Percent Past 20 80 120 40 60 100 140 Years of Life

3. % of total DALYs lost Energy excess Under nutrition

4. Cause of Death by WHO region WHR 2002

5. * * * * * Risks Associated to Global Deaths 2000 * * * Significantly determined by diet and PA (x 000)

6. Technical Report Series 916 www.who.int/hpr/nutrition/ExpertConsultationGE.htm

7. Dietary energy Supply (DES) & Overweight %Overweight 50 1961 40 30 20 1999 2400 3200 3800 DES Kcal/kg/d Kcal/kg/d

8. % Obesity Prevalence by GNP % Obesity by Education & GNP Highest Quartile Lowest Quartile Less educated More educated Very poor Poor GNP US $ per caput GNP US $ per caput Monteiro and Popkin 2004

9. Primitive Life Modern Life Energy Expenditure Energy Expenditure Increase Expenditure Expenditure>Intake Intake>Expenditure Reduce Intake Limited Intake Unlimited Intake Energy Intake Energy Intake Increase in Energy Stores Energy balance established at unhealthy weight. Low Energy Stores (body fat)

10. YOU CAN ENHANCE YOUR CHANCES FOR A LONG AND HEALTHY LIFE BY CHANGING YOUR: MOTHER FATHER DIET and Activity level

11. Total fat Saturated Fats (C14,C16) Trans fatty acids Refined starches Free sugars Sodium/salt Preserved meats PHYSICAL ACTIVITY Vegetables Fruits, legumes Fibre/NSP w - 3 fatty acids (EPA+DHA) Iron/iodine/Zinc Folate Principal nutrient/food changes Reduce Increase

12. Why do we need to limit intake of added sugars : • Sugars provides empty calories: this means that depending on how much sugars you consume you may be getting insufficient amounts of vitamins and minerals. • Sugars please our brain, promote insulin secretion and especially as sweet drinks lead to unbalanced energy intake • Sugars increase energy density of foods may aggravate the metabolic syndrome in people with the metabolic syndrome (visceral obesity, diabetes, heart disease, high BP)

14. Cuba

15. BMI changes during Crisis Females Males

16. Dietary factors in epidemic neuropathy on the Isle of Youth, Cuba. Gay J, Porrata C, Hernandez M, Clua AM, Arguelles JM, Cabrera A, Silva LC.Institute of Nutrition and Food Hygiene, Havana, Cuba. An epidemic neuropathy that broke out in Cuba in late 1991 has exhibited clinical manifestations similar to those of other poly neuropathies of nutritional origin, … …..a broad range of specific dietary deficiencies, a sugar intake exceeding 15% of total caloric intake, ….and smoking….. Sugars provide empty calories Bull Pan Am Health Organ. 1996 Mar;30(1):87-9.

17. sweet drinks lead to increase body weight Sugar sweetened drinks lead to unbalanced energy intake sweet drinks lead to increase body fat A. Raben et al Am JClin Nutr 2002;76:721–9.

18. The paraventricular & arcuate nuclei contain neurons capable of stimulating/inhibiting food intake. Y1R/Y2R denote subtypes of the neuropeptide Y (NPY) rec MC4R melanocortin 4 rec PYY peptide YY 3–36, GHsR GH hormone secretagogue rec AgRP agouti-related protein, POMC propio o melanocortin a-MSH a -melanocyte–stimulating protein LEPR leptin rec, and INSR insulin rec. Sugars please our brain, promote insulin secretion Korner J and R Leibel NEJM 349;10 2003

19. Suppression of insulin secretion with drug NR Subjects non responsive to blocking insulin with drug HR Subjects responsive to blocking insulin with drug Velasquez et al Int J of Obesity (2003) 27, 219–226.

20. Non Responsive Highly Responsive Blocking insulin secretion decreases Energy intake Non Responsive Highly Responsive Lustig et al 2003

21. Sugars increase energy density & elevate intake Home foods Fast foods Prentice & Jebb Obesity reviews 187–194 (2003)

22. Effect of High Sugar on BMI Control diet Low Fat High Sugars Low Fat High Complex-CHO aggravate the metabolic syndrome Effect of High Sugar on Body Weight Control diet Low Fat High Sugars Low Fat High Complex-CHO S PoppittAm J Clin Nutr 2002;75:11–20.

23. Effect of High Sugar on Total Cholesterol Low Fat High Sugars Control diet Low Fat High Complex-CHO Effect of High Sugar on Triglycerides Low Fat High Sugars Low Fat High Complex-CHO Control diet S Poppitt et al Am J Clin Nutr 2002;75:11–20.

24. Reduced Glycemic Load Reduced Fat Effects of Glycemic Load on BMI and Body Fat Change in Fat mass (kg) Change in BMI (kg/m2) Treatment x time effect: p < 0.05 Treatment x time effect: p < 0.05 3 2 2 1 Lowering Sugars reduces body weight and fat mass 1 0 0 -1 -1 -2 -2 -3 -4 -3 -5 0 6 12 6 12 0 Time (months) Time (months) Ebbeling CB et al Arch Pediatr Adolesc Med. 157: 773-9. 2003

25. Why do we need to limit intake of added sugars : • Sugars provides empty calories: this means that depending on how much sugars you consume you may be getting insufficient amounts of vitamins and minerals. • Sugars please our brain, promote insulin secretion and especially as sweet drinks lead to unbalanced energy intake • Sugars increase energy density of foods may aggravate the metabolic syndrome in people with the metabolic syndrome (visceral obesity, diabetes, heart disease, high BP)

26. CHOOSE SENSIBLY . . . 'provide food options that are low in fat, calories and added sugars, “promote healthier choices including at least 5 servings of fruits and vegetables a day, reasonable portion sizes, encourage the food industry to provide reasonable food and beverage portion sizes, encourage food outlets to increase the availability of low-calorie, nutritious food items.” In a dietary pattern of any calorie level, if the consumer eats the recommended amounts of vegetables and fruits, grains, low-fat meats and beans, low-fat dairy products, and additional fats, then the …consumer should have a few calories left over. These extra calories may be filled with added sugars. CDC website http://www.cdc.gov 2004 http://www.health.gov/dietaryguidelines/dga2000

27. USDA Food Based Dietary Guidelines added sugars * 1 teaspoon sugar = 4 grams 1 gram sugar = 4 kcal

28. The Honorable Tommy G. Thompson Secretary of Health and Human Services The USA IOM report’s recommendations regarding added sugars have been widely misinterpreted. I am writing to clarify the intent of the report. … The report states “A. maximal intake of 25 percent or less of energy from added sugars is suggested. This maximal intake level is based on ensuring sufficient intakes of certain essential micronutrients that are not present in foods and beverages that contain added sugars. A daily intake of added sugars that individuals should aim for to achieve a healthy diet was not set.” This language is not meant to convey a desirable or even acceptable standard intake. The report states that persons whose intake of added sugars is 25% or more of total calories are more likely to have poorer intakes of important essential nutrients. It does not address the issue that added sugar intakes at 25% or even well below it, may well have significant implications for caloric balance and weight control. Interpretations suggesting that a sugar intake of 25% of total calories is endorsed by the Institute’s report are incorrect. It is our intent to clarify the language in the report to address this point before it is published in final text. However, I wish to clarify the report’s findings immediately so that the mischaracterization of the findings is not misleading to the public or to policy-makers. Harvey V. Fineberg, M.D., Ph.D. Sincerely, President Institute of Medicine USA April 15, 2003

29. In the absence of definitive evidence, recommendations must rely on professional judgment. No data suggest that sugar intake per se is advantageous, and some data suggest it may be detrimental. The studies above, taken in total, indicate that high sugar intake should be avoided. Sugar has no nutritional value other than to provide calories. To improve the overall nutrient density of the diet and to help reduce the intake of excess calories, individuals should be sure foods high in added sugar are not displacing foods with essential nutrients or increasing calorie intake. American Heart Association,Circulation.;106:523-527 2002 Circulation is available at http://www.circulationaha.

30. WHO Strategy on Diet, Physical Activity and Health WHA 2004 Phase III EB Jan 2004 Reference group Secretariat Consultation Process UN agencies Phase II Member states Civil Society Private sector Preparation of consultation process and finalization of expert report Phase I

31. Behavioral change is needed Modern Humans