© food – a fact of life 2011 priority health issues georgine leung nutrition scientist british...

© Food – a fact of life 2011

Priority health issues

Georgine Leung

Nutrition Scientist

British Nutrition Foundation


Priority health issues

• Diabetes mellitus

• Nutrition, health and schoolchildren- Major nutrition issues- School food provision

• Energy balance


Diabetes mellitus

Diabetes is the major cause of premature illness and death in most countries.

There are two main types: Type 1 and Type 2.

Currently, there are 2.8 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it (Diabetes UK 2011).


Diabetes mellitus

This is a condition where the amount of blood glucose is too high because the body cannot use it properly.

The pancreas does not produce any insulin or not enough – or the insulin that is produced does not work properly (known as insulin resistance).

This can result in raised blood glucose, known as hyperglycaemia, which can adversely affect brain function. Cells are not able to take up glucose and use it as a fuel, resulting in fatigue and weight loss.


Type 1 diabetes

This is also known as insulin-dependent diabetes and is an auto-immune condition in which the immune system of the body turns against itself.

This disease causes permanent damage to particular cells in the pancreas that produce insulin.

Possible causes include viral or other infection, with a genetic predisposition.

This can be managed by injections of insulin with a healthy diet.


Risk factors• Family history.

• Ethnicity.

• Overweight or obese (especially central obesity).

• Impaired glucose tolerance or fasting glycaemia.

• High blood pressure and history with heart attack or stroke.

• History of gestational diabetes.

• Severe mental health problems.


Type 2 diabetes

This is also known as non-insulin dependent diabetes and occurs when the body does not produce enough insulin or the insulin produced does not work properly (insulin resistance).

Usually develops in middle-aged people and in later life, but has been seen in younger adults (particularly South Asian and African-Caribbean people) and also recently amongst overweight teenagers in the UK.

Can often be prevented and reversed in the early stages through changes in health behaviours.


Some myth-busting…

Despite popular belief, there is no evidence to suggest that a high consumption of sugars causes diabetes.


Carbohydrate and diabetes

Large intakes should be avoided, but they do not need to be omitted from the diet.

The diet recommended for individuals with diabetes should be high in complex carbohydrates and low in fat, similar to the rest of the population.

Individuals who take insulin to control their diabetes need to eat adequate amounts of carbohydrate foods at regular intervals to help them control their blood glucose levels.


Glycaemic index (GI)

GI is a ranking of foods to measure how quickly glucose is released into the bloodstream after eating.

Low GI foods break down slowly during digestion and release glucose slowly into the blood.

Glucose or white bread is used as the standard reference (GI 100), and other foods are measured against this.


Glycaemic index (GI)

Addition of fat and protein slows down the process at which carbohydrate is absorbed and lower the GI. If people confine themselves to low GI foods only, their diet may become unbalanced.

Also affected by the cooking method, processing, the ripeness of a fruit, the variety of a vegetable, the structure and texture of a carbohydrate etc.

The GI of a food only informs how quickly or slowly it raises the blood glucose when the food is eaten on its own, but foods are usually eaten as part of a meal.


Glycaemic index (GI): examples

Low GI Medium GI High GI

Apples, oranges, pears and peaches

Honey and jam Glucose

Beans and pulses Shredded wheat White and wholemeal bread

Pasta Ice-cream Brown rice, cooked

Sweet potato, peeled and boiled

New potatoes, peeled and boiled

White rice, cooked

Sweet corn White basmati rice, cooked

Cornflakes

Porridge Pitta bread Baked potato

Custard Cous cous Mashed potato

Noodles

All bran cereals

(Diabetes UK)


Eating well with diabetes

1. Eat three meals a day.2. Include starchy foods at every meal.3. Cut down on fat, especially saturated fat.4. Eat more fruit and vegetables.5. Include more beans and pulses.6. Aim for at least two portions of oily fish a week.7. Limit foods high in sugar.8. Reduce salt in the diet.9. Drink alcohol in moderation only.10.Don’t use diabetic food or drink.

(Diabetes UK 2010)


Nutrition, health and school children

Micronutrient levels in school children


Some regional differences in Scotland

Boys in Scotland were less likely to have eaten all types of fish (including oily fish) than children elsewhere.

Boys and girls in Scotland were also less likely to have consumed many types of vegetables than children in other regions (lower vitamin C status)

Chocolate confectionery was also more likely to be consumed in boys in Scotland compared with London and the South East (94% compared with 82%).

(Gregory et al. 2000)


Iron-deficiency anaemia

Globally, 50% of anaemia cases are linked to low iron intakes, which is common amongst UK girls of 11 to 18 years (46% reported levels below the LRNI).

Around 90% of dietary iron is available in non-haem form, which is influenced by the presence of other components such as vitamin C and phytates.

Anaemia is common in girls who had tried to lose weight over the past year and amongst vegetarians. Symptoms include fatigue and poor cognition in children (also linked to socioeconomic and biomedical disadvantages).


Bone health

Most of the skeletal mass is laid down during childhood and adolescence (80-90% peak bone mass). Nutrition and physical activity play an important role in bone development.

• Calcium – 99% stored in bone and teeth.

• Vitamin D – helps absorb calcium.

• High-impact weight-bearing physical activities.


School food provision

• School food standards

• Scotland’s free fruit and veg scheme

• Free school meals

• Packed lunches

• Breakfast clubs

Plus… Food in the curriculum!


Summary of food standards for school lunches in ScotlandFruit and vegetables A choice of at least two types of vegetables and two types of fruit (not

including fruit juice) must be provided every day as part of the school lunch.

Oily fish Oily fish must be provided at least once every three weeks.

Variety of extra bread Additional bread must be provided every day as a meal accompaniment, with a variety of bread, which must include brown or wholemeal, being provided over the week.

Oils and spreads Only oils and spreads high in polyunsaturated and/or monounsaturated fatty acids can be used in food preparation.

Deep-fried foods Menus must not contain more than three deep-fried items in a single week.

Table salt and other condiments

Additional salt cannot be provided.Condiments must be dispensed in no more than 10ml portions

Confectionery No confectionery can be provided

Savoury snacks No savoury snacks can be provided except savoury crackers, oatcakes or breadsticks.

(The Scottish government 2008)


Summary of nutrient standards for school lunches in Scotland


Energy balance

Levels of overweight and obesity are increasing, latest figures show around 68.5% men and 61.8% women in Scotland are overweight (including obese) (The Scottish Government 2010).

Young women, especially teenage girls, often try to control their weight by adopting very low energy diets or smoking but restricted diets may lead to nutrient deficiencies and other health consequences.

People of unhealthy weight may need guidance on lifestyle changes to help them achieve a healthy weight.


Overweight and obesity amongst Scottish children


Healthy lives, healthy people: A call to action on obesity in England

In order to reduce the prevalence of overweight and obesity in the population, energy balance needs to be shifted. This can be done by reducing energy consumed (consuming fewer calories), increasing energy expended (increasing physical activity) or both.

The government’s call for action focuses on the need to reduce energy intake and emphasises that we all have a part to play. In particular it calls for a reduction in the energy content of the food supply and for the food industry to reduce the number of calories provided by their products.


New SACN report on energy requirements

The average dietary energy requirements for infants, children, adolescents and adults in the UK have been revised. For example, for adults:

This does not mean that people have become more active or that they should eat more. The new values are based on more up to date methods, which have provided us with greater understanding of current physical activity levels.

Population average : 2550kcal (10.6MJ) 2605kcal (10.9MJ) per day

Population average: 1940kcal (8.1MJ) 2079kcal (8.7MJ) per day


SACN have noted that population groups who are overweight (body mass index of 25 kg/m2 or more) are likely to benefit from reducing the amount of calories consumed.

Increased physical activity is also likely to benefit health, and may help reduce body weight particularly if combined with a reduction in energy intake.

New SACN report on energy requirements


(Daily mail 2011)


Positive energy balance

Energy inFood and drinks

Energy outActivity

Being overweight and obese increase risk of: certain cancers, heart disease, stroke and Type 2 Diabetes.


Negative energy balance

Energy inFood and drinks

Energy outActivity

Underweight can lead to: hair loss, dry, patchy skin, weakened immune system, osteoporosis, infertility and heart failure


• It is very important to achieve a healthy weight

• Body Mass Index (BMI) =

Monitoring energy balance

weight (kg) . height

(m) x height (m)

Recommended BMI range (kg/m2)Underweight less than 18.5Normal 18.5 - less than 25Overweight 25 - less than 30Obese 30 - 40Very obese over 40


Physical activity

• Physical activity through life is important for maintaining energy balance and overall health.

• New UK wide activity guidelines published in 2011.

• All activities count – sit less, move more!


Physical activity for children and young people

(5-18 years)All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day.

Vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least 3 days a week.

All children and young people should minimise the amount of time spent being sedentary (sitting) for extended periods.

Source: Department of Health (2011): UK Physical Activity Guidelines


Physical activity for adults

(19-50 years)Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hours) of moderate intensity or 75 minutes of vigorous intensity activity.

Adults should also undertake physical activity to improve muscle strength on at least two days a week and minimise the amount of time spent being sedentary (sitting) for extended periods.



Physical activity for older adults

(65+ years)Older adults should aim to be active daily, for at least 150 minutes (2 ½ hours) of moderate intensity activity or 75 minutes of vigorous intensity activity each week and minimise the amount of time spent being sedentary (sitting) for extended periods.

Older adults should also undertake physical activity to improve muscle strength on at least 2 days a week. For those who are at risk of falls, they should incorporate physical activity to improve balance and co-ordination at least 2 days a week.



Dietary recommendations

We should consume a variety of foods from each of the four main food groups of The eatwell plate:

Fruit and vegetablesBread, rice, potatoes,

pasta and other starchy foods

Milk and dairy foodsMeat, fish, eggs, beans

and other non-dairy sources of protein


For further information, go to:

www.nutrition.org.uk

www.foodafactoflife.org.uk

© food – a fact of life 2011 priority health issues georgine leung nutrition scientist british...

Documents

diabetes mellitus diabetes

fact of life

insulindependent diabetes

diabetes uk

noninsulin dependent

insulin resistance

later life

injections of insulin