badenweilernutrition and physical activity26.02.2007 b. kurth the impact of unhealthy diets dr....
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BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
The Impact of Unhealthy DietsDr. Bärbel-Maria Kurth
Badenweiler, GermanyConference from 25 – 27 February 2007
Prevention for HealthNutrition and Physical Activity – A Key to Healthy Living
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
Dietary Habits and Health What do we know? What is recommended ?
Epidemiological Background in Europe Knowledge of Dietary Habits European Activities for HarmonisationNational Activities Nutritional Report of the Netherlands:
„Our Food-Our Health“ Health and Nutritional Surveys in
Germany
Vision for Europe European Public Health Nutritional
Concept
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
Dietary Habits and Health What do we know?
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Evidence for relationships between nutrients and several chronic diseases (adapted from RIVM 2004, WHO 2003)
Obesity Type 2 Cardiovascular Cancer Dental Osteo-
diabetes diseases disorders porosis Energy and fats High intake of energy-dense food Saturated fatty acids Trans fatty acids Dietary cholesterol Myristic acid and palmitic acid Linoleic acid Fish and fish oil (EPA and DHA) Phytosterols and phytostanols α-Linolenic acid Oleic acid Nuts (unsalted)
Carbohydrates High intake of dietary fibre Free sugars Sugar-free chewing gum Wholemeal cereal products
Vitamins Vitamin D Folic acid
Minerals High sodium intake Products preserved in salt and salt Potassium Calcium Fluoride
convincingly increases risk; probably increases risk; convincingly decreases risk; probably decreases risk
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Evidence for relationships between foods and several chronic diseases (adapted from RIVM 2004, WHO 2003)
convincingly increases risk; probably increases risk; convincingly decreases risk; probably decreases risk
Obesity Type 2 Cardiovascular Cancer Dental Osteo- diabetes diseases disorders porosis Meat Canned meat Fruit and vegetables Fruit and vegetables Non-alcoholic beverages Sugar-sweetened soft drink and fruit juice Very hot beverages (and food) Unfiltered boiled coffee Alcoholic beverages High alcohol intake Low to moderate alcohol intake Others Hard cheese Exclusive breastfeeding
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Recommendations for „healthy diet“:
Balanced diet: British Journal of Nutrition, Vol. 92 supplement 2, October 2004 or Dietary Guidelines for Americans: www.helathierus.gov/dietary guidelines or the nutritional pyramid of the US Department of Agriculture: www.mypyramid.gov
EURODIET recommends: “Guidelines should first be developed for individual member states.”
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The 5 a day initiative: (Started by the NIH, USA)Model projects in several European Countries
Promoted by many organisations, WHO, the European Commission, the World Cancer Research Fund,the German Cancer Society, the IARC
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
Epidemiological Background in Europe
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Knowledge of Dietary Habits
European Nutrition and Health Report 2004(Forum of Nutrition, Vol. 58):
Summarising National Nutrition ans Health Reports:
•Too high intake of fat, especially saturated fat•Generally too high intake of alcohol, especially for men•Too high availability of meat and meat products•In some countries low availability of fruits and vegetables•Generally inadequate intake of some vitamins and minirals•Alarming high prevalence of overweight and obesity
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European Activities for Harmonisation
EURODIET project (2000):Methodological differences between the European countries in approaches to dietary surveys have a remarkable influence on the results and their comparability.
European projects: Developing standardised method for dietary surves:EFCOSUM (European Food Consumption Survey Method) EFCOVAL (European Food Consumption Validation) Establishing a European nutritional data base:EuroFir-Projekt (European Food Information Resource Network) EUROFOODS-ENFANT (European Network on Food and Nutrition Tables
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
National Activities Nutritional Report of the Netherlands
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Our food, our healthHealthy diet and safe food in the Netherlands (2006)
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
Our food, our healthHealthy diet and safe food in the Netherlands (2006)
Goals:
Stopping the further increase of the prevalence of overweight in the population
Balanced Diet:Proper composition of fatty accids in the dietregular fish consumption,adequate fruit and vegetables intake
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Priority 1: The promotion of healthy diet, which involves a two-pronged approach:
Healthy diet
Promotion of a healthy composition of diet
Reduction of overweight and obesity
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
National Activities Health and Nutritional Surveys in Germany
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
Health and Nutritional Surveys in Germany
Knowledge of the composition of diet
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Main sources of energy intake in Germany (National Health Survey 1998, German Population 18-80 years)
0 5 10 15
Potatoes
Fruit
Cereals
Beer
Plant oil/fat
Meat
Sausage
Sweets
Bread
Milk, Milkprod
Men
0 5 10 15
Animal Fat
Cakes
Meat
Sausage
Cereals
Plant oil/fat
Fruit
Sweets
Bread
Milk, Milkprod
Women
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Intake below recommended level (National Health Survey 1998, German Population 18-80 years)
0 20 40 60 80 100
Dietary fiber
Vitamin D
Vitamin E
Folate
Calcium
Iron
Men Women
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Percentage of adults which consume more than 400 g fruits and vegetables per day (excluding juices) (National Health Survey 1998, German Population 18-80 years)
0 10 20 30 40 50 60 70
18-24
25-34
35-44
45-54
55-64
65-79
Age
%
Men Women
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National Health Survey for children and adolescents (0-17 years)Germany 2003-2006 (KiGGS)
The survey was conducted from May 2003 till May 2006 in 167 cities and communities (Sample Points).
Boys and girls aged 0 to 17 years were chosen randomely from population registries.
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(KiGGS) : Self-administered Questionnaire: parents, children, adolescents
Physical Health, Diseases
Mental Health, Problems
Social Health, Living conditions
Lifestyle, Health Behaviour,Health Risks
Health Care
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(KiGGS): Physical Measurements and Tests
anthropometry
vision tests
blood pressure, heart rate
motor activity, co-ordination
sonography of the thyroid gland
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National Health Interview and Examination Survey of Children and Adolescents (KiGGS)
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Percentage of boys and girls with daily fruit consumption (KiGGS results)
0
10
20
30
40
50
60
70
80
3-6 y. 7-10 y. 11-13 y. 14-17 y. 3-6 y. 7-10 y. 11-13 y. 14-17 y.
Boys Girls
%
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0
10
20
30
40
50
60
70
3-6 y. 7-10 y. 11-13 y. 14-17 y. 3-6 y. 7-10 y. 11-13 y. 14-17 y.
Boys Girls
%
Percentage of boys and girls with daily vegetable consumption (KiGGS results)
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0,0
10,0
20,0
30,0
40,0
50,0
60,0
3 - 6 y. 7 - 10 y. 11 - 13 y. 14 - 17 y. 3 - 6 y. 7 - 10 y. 11 - 13 y. 14 - 17 y.
Boys Girls
%
Percentage of boys and girls with daily soft drinks consumption (KiGGS results)
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Outlook: EsKiMo -The Eating study as a KiGGS Module
A nutrition survey in 2006 in a subsample of KiGGS
Parents of children aged 6-11 years filled in a 3 day dietary record
Participants aged 12-17 years were interviewed at home (diet history)
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
Health and Nutritional Surveys in Germany
Overweight and obesity
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Prevalence of Obesity (95% Confidence Interval) National Health Surveys from 1984 to 1998, Men
Alte Bundesländer Neue Bundesländer
1984 1987 1991 1998 1992 199810%
15%
20%
25%
30%
H. Knopf, G. Mensink, E. Bergmann, Th. Lampert
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(KiGGS): Prevalence of overweight and obesity Children and adolescents 3-17 years
Clear increase over reference data from 1985-1999.No differences between boys and girls.
Overweight Subgroup: Obesity
10%
3%
Prevalence of overweight
Boys Girls Total 0%
4%
8%
12%
16%
20%
24%
15 15 15
Prevalence of obesity
Boys Girls Total 0%
4%
8%
12%
16%
20%
24%
6.3 6.4 6.3
Prevalence of overweight
Boys Girls Total
0%
4%
8%
12%
16%
20%
24%
15 15 15
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(KiGGS): Prevalence of overweight by age groups
Strong increase in primary school age, afterwards only a slight further increase.
10%
Prevalence of overweight
Boys Girls
0%
4%
8%
12%
16%
20%
24%
3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs
8.9
16
1817
9.3
15
1917
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(KiGGS): Prevalence of obesity by age group
Strong increase in primary school age, especially in boys.
3%
Prevalence of obesity
Boys Girls
0%
4%
8%
12%
16%
20%
24%
3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs
2.5
7.0 7.08.2
3.3
5.77.3
8.9
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(KiGGS): Prevalence of obesity by socioeconomic status
Obesity is more prevalent in children coming from families with lower socioeconomic status.
obesity, stratified by socioeconomic status
low middle high
0%
4%
8%
12%
16%
20%
24%
3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs
4.4
9.8
1214
3.0
6.3 5.97.5
1.33.0 3.6
5.2
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(KiGGS): Prevalence of obesity by migration status
Children with migration background show higher obesity prevalences
obesity, stratified by migration status
migration backgroundno migration background
0%
4%
8%
12%
16%
20%
24%
3-6 yrs 7-10 yrs 11-13 yrs 14-17 yrs
4.9
11 10 9.4
2.4
5.4 6.48.3
BadenweilerNutrition and Physical Activity 26.02.2007 B. Kurth
Vision for EuropeEuropean Public Health Nutritional Concept
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European Community Health Indicator Project (ECHI)
European Community Health Indicator Project (ECHI),collecting comparable health indicators for application in all European countries “short list”: Indicators recommended as basis for European data collection.
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European Community Health Indicators (ECHI-shortlist) for Nutrition & Health
Health Determinants Health Effects
Total Energy IntakeBody Mass Index, Prevalence of Overweight and Obesity
►
Consumption and availability of vegetables
► Self-perceived health ►
Consumption and availability of fruits
► Blood pressure
Alcohol consumption (Hazardous alcohol consumption)
► Diabetes, Prevalence ►
Physical Activity ► Cardiovascular Morbidity ►
Health Interventions: Health Promotion
Alcohol-related deaths
Policies on healthy nutrition Limitations in physical functions ►
Policies and practices on healthy lifestyle
Life expectancy and
Disability-free life expectancy (DFLE)
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European Community Health Indicators (ECHI) referring to nutrition
Available ECHI-indicators Limited available (Coverage/Comparability/Time)
BMI, Prevalence of Overweight and Obesity
Total Energy Intake
Diabetes (Mortality, Hospital disch.) Consumption and availability of vegetables and fruits
Alcohol consumption Alcohol-related deaths
Self-perceived health Limitations in physcial functions
Life expectancy and DFLE Blood pressure
Cardiovascular Mortality Cardiovascular Morbidity
Physical activity
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European Health Interview Survey
In case that recommended indicators will be integrated the comparability of food patterns will be achieved.
Result: •Setting European Priorities•European recommendations for balanced Diet•European activities for healthy diet
and…..
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Our food, our health
Healthy diet and safe food in Europe