a kína t anulmány
DESCRIPTION
A legnagyobb epidemiológiai vizsgálat a táplálkozás és a krónikus betegségek összefüggésében. A Kína T anulmány. Heath Trends since 1950. Overweight, obesity, NIDDM Dementias (AD = ‘Type 3 diabetes’) Hypertension: 25% of US adults (USDA 2000) Pre-hypertension: 30% of US adults (AR)MD - PowerPoint PPT PresentationTRANSCRIPT
A Kína Tanulmány
A legnagyobb epidemiológiai vizsgálat a táplálkozás és a
krónikus betegségek összefüggésében
Heath Trends since 1950Heath Trends since 1950• Overweight, obesity, NIDDM• Dementias (AD = ‘Type 3 diabetes’)• Hypertension: 25% of US adults (USDA 2000)• Pre-hypertension: 30% of US adults• (AR)MD• Eosinophilic GI disorders; ‘explosive growth’ (Noel
et al ’04)
• Non-tobacco related cancers: 100% increases• lymphoma, leukaemia, melanoma, germ cell
tumours in teens & young adults (NCIC ‘04)
• ADD/ADHD/dysphasia/dyspraxia (U. Washington ’05)
Rising health costsRising health costs
£ billion 1960 1970 1980 1990 1994
EU 5 17 107 291 410 US 10 31 108 390 617
UK 1 2 13 33 46
WHO 2000WHO 2000
Rising health costsRising health costs
£ billion 1960 1970 1980 1990 1994
EU 5 17 107 291 410 US 10 31 108 390 617
UK 1 2 13 33 46
% GDP 1960 1970 1980 1990 1994 EU 3.7 5.4 7.2 7.3 7.8 US 5.2 7.3 9.3 12.7 14.3 UK 3.9 4.5 5.6 6.0 6.9
WHO 2000WHO 2000
20062006
19.719.7
Iatrogenic Deaths (USA)Iatrogenic Deaths (USA)
• Total > 250,000 / year (3rd leading c.o.d)
• 7,000 - medication errors (in hospitals)• 20,000 - other hospital errors• 80,000 - hospital-acquired infections • 106,000 - adverse effects of drugs• 12,000 - unnecessary surgery
Starfield B et al: JAMA 284:483-5 2000
Reduced energy Reduced energy expenditureexpenditure
1600
1800
2000
2200
2400
2600
2800
60 65 70 75 80 85 90 95Year
kcal
per
day
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
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)
Positive energy balancePositive energy balance
1600
1800
2000
2200
2400
2600
2800
60 65 70 75 80 85 90 95Year
kcal
per
day
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
1952
1952
2001
The Western Diet
• High fat & refined carbs• High calorific density• Low micronutrient / calorie ratios Type
B malnutrition
• Foods which are energy-dense & low fibre: do not satiate ‘passive over-eating’ (‘up-sizing’) overweight
Hardee’s ‘Monster Thickburger’Hardee’s ‘Monster Thickburger’
1420 calories, 107 g fat: $5.491420 calories, 107 g fat: $5.49
PepsiPepsi
PizzaPizza
Real World Pyramid
Dietary shift 1950 - 1997Dietary shift 1950 - 1997
• World consumption of calories from meat increased 36%• “ “ calories from vegetable oil increased 46.2% • US & EU “ sugars and starches increased 35%
• World consumption of calories from complex carbohydrates fell 38%
• UK consumption of fresh vegetables fell 24%
• Per capita income closely related to energy availability • In countries where per capita income increased, so did average
caloric consumption • High-income nations derive most energy from sugars and fats –
poorer nations catching up rapidly
(USDA, Worldwatch, FSA, Drewnowski ’77 & ‘03)
Nutrition in children & AdolescentsNutrition in children & Adolescents
• Most commonly eaten foods: bread, savory snacks, crisps, chips, boiled, mashed and jacket potatoes, biscuits, chocolate confectionery.
• 5 veg / fruit per day: < 50%• 0 fruit per day: 20 - 30%• 0 veg per day: 4%• Dieting: 15% girls, 3% boys
National Diet & Nutrition Survey National Diet & Nutrition Survey 20002000
DIETARY SHIFTDIETARY 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
% Depletion Vitamins% Depletion Vitamins
C E A B1 B2 C E A B1 B2 NiacinNiacin FolateFolate B6 B12 B6 B12------------------------------------------------------------------------------------------------------------------------------------------37 68 55 32 31 27 34 54 1737 68 55 32 31 27 34 54 17%
(USDA 1997)
Fat - but Fat - but starvingstarving
• W.H.O. ‘02: ‘Globally, overweight greater health problem than underweight.’
• W.H.O./F.A.O ’03: ‘Poor diet the major cause of degenerative disease’.
• U.N. ’06: Overweight but malnourished• 40-60% hospital admissions malnourished (1-3)
• 25-30% malnourished in the community J Nutr Hlth Ageing 3:133-139, ‘99
• > > 3.6 million malnourished in UK (BANT ’07)
MICRONUTRIENTSMICRONUTRIENTS CALORIESCALORIESMALNUTRITIONMALNUTRITION
TYPE A
MICRONUTRIENTSMICRONUTRIENTS CALORIESCALORIESMALNUTRITIONMALNUTRITION
TYPE A
TYPE B