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  1. - Weight Management - cardiovascular disease & diabetes Paul Clayton Sundevollen 20/5/07

  2. 1897

  3. 1919

  4. Korea 1951

  5. Fife 1953

  6. California 1955

  7. 1957

  8. 1957

  9. 1957

  10. 2001

  11. ob/ob normal Ob /

  12. 1885: first automobile (Karl Benz)

  13. 1912: first traffic jams

  14. 1929: first parking problems

  15. Reduced energy expenditure 1940 50 60 70 80 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

  16. Positive energy balance 1940 50 60 70 80 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

  17. Obesogenic culture (AHA ’03) Avge US adult sedentary 8 hours / day, < 2,000 steps / day (NYS Public Health Assocn ‘05) Amish 16,000 steps /day: obesity 9% women, 0% men (Bassett et al ’04)

  18. Positive energy balance 1940 50 60 70 80 90 2000 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

  19. AHA 2002: ‘obesogenic culture’ • Fewer bus-stops, remote parking • Exercise to be mandatory at all levels of educational system • No ‘junk foods’ to be sold / served in schools • ‘baby bells’: constructive inconvenience

  20. Why is weight gain so easy? • Multiple satiation mechanisms • Protein: amino acids (fish > whey > casein) • Fats: fatty acids (distal jejeunum) • Carbs: glucose (Hoodia) • Fermentable carbs: SCFA (propionic) • Insufficient calorific throughput • High calorific density • Instant gratification

  21. Positive energy balance 1940 50 60 70 80 DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

  22. Overweight but starving • W.H.O. ‘02: ‘Globally, overweight more of a health problem than underweight.’ • U.N.O. ’06: ‘Overweight but malnourished’ (=Type B malnutrition) • 40-60%hospital admissions malnourished(US/UK) • And in the community (USDA and other surveys)

  23. MALNUTRITION TYPE A MICRONUTRIENTS CALORIES

  24. MALNUTRITION TYPE A TYPE B MICRONUTRIENTS CALORIES

  25. Vitamins C E A B1 B2 NiacinFolate B6 B12 --------------------------------------------------------------------- 37 68 55 32 31 27 34 54 17 % Percentage of Population Depleted In Vitamins (USDA 1997)

  26. * Gregory et al 2000. National Diet and Nutrition Surveys, HMSO

  27. * Gregory et al 2000. National Diet and Nutrition Surveys, HMSO

  28. DIETARY SHIFT • Flavonoids 75% • Vit C 50-60% • Omega-3 50% • Methyl groups 95% • Carotenoids 40% • Phospholipids 50% since 1900 • Selenium 50% ” 1960 (UK) • Prebiotic fiber 50% ” 1960 (Fr) • Sterols 66% ” 1960 (SA) since Stone Age

  29. WHO Technical Report Series 916 • ‘Diet, Nutrition and the Prevention of Chronic Diseases’ • Report of Joint FAO / WHO Expert Consultation Geneva May 2003

  30. RSM 2005: Pathogenic culture? heart disease, stroke, cancers, kidney disease, blindness, Alzheimer’s • Type 2 diabetes • Osteoporosis • ARMD • Neurodegenerative disease • Lymphoma, leukaemia, melanoma, germ cell tumours in teens & young adults • ADD / ADHD / dysphasia / dyspraxia • Allergy, asthma

  31. Type B Malnutrition worsens with age • Reduced activity / calorie requirements • Institutional diet • Financial hardship • Poor dentition • Swallowing problems (xerostomia) • Loss of sense of taste

  32. Type B Malnutrition worsens with age • Progressive depletion of anabolic factors (vits C, B’s, D; Zn, Cu, Se, Fe, Ca, Mg; amino acids etc) • Progressive depletion of anti-catabolic factors (vit E; Zn, Cu, Mn, Se; sterols, flavonoids, carotenoids etc)

  33. Type B Malnutrition worsens with age • Progressive depletion of anabolic factors  decreased tissue repair, damage clearance etc • Progressive depletion of anti-catabolic factors   increased free radical activity, hexosylation, nitrosation, inflammation = CATABOLIC DOMINANCE

  34. Multiple agent intervention • CDD’s have multiple patho-aetiology • CAD risk factors: hypertension, smoking, inactivity, obesity LDL / HDL, LDL-ox.lag, HbA1c, hyperHc, ICAM-1, VCAM-1, VWF etc • Reduced risk: lycopene, quercitin, omega 3, methyl groups, alcohol, lutein, vitamin E, soy etc

  35. CVD: HOW DRUGS WORK

  36. CVD: HOW DRUGS WORK

  37. CVD: HOW DRUGS WORK

  38. CVD: HOW DRUGS WORK