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A Clinical & Public Health Framework
For Food-Related HealthFood Matters: A Clinical Education and Advocacy ProgramInsert Presenter Name and Title
Insert Date and Location of Presentation
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Food Matters: A Healthcare Education and Advocacy
Program
To inspire clinicians to:
Provide anticipatory guidance to patients and families about the importance of healthy foods and a healthy food system.
Work within health care facilities to create a healthy food service model that is recognized as integral to a preventive health agenda.
Work within the community at a local, regional and national level to promote policies that support the development of a healthy, accessible, and fair food system.
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Clinical advisory group
Clinical curriculum development and trainings
Nationwide clinical network
Maternal/Child health calendar
Video for waiting rooms, clinics, exam rooms, community meetings
Healthy Food in Health Care campaign for healthier, more sustainable foodservice
Components of the Food Matters Program
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Guiding Rationale An Ecological Health FrameworkThe individual in the context of family, community, society and ecosystem
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Guiding Rationale A Food Systems Approach
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Healthy food comes from a food system that is
ecologically soundeconomically viable, and
socially responsible.
Guiding Rationale A Food Systems Approach
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Interconnections Between Nutrition and Environment
Barilla Centre for Food and Nutritionwww.barillacfn.com
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Hospitals and healthcare professionals can be leaders and advocates for a food system that promotes public and environmental health.
Healthcare professionals have credibility, influence, and expertise.
Anti-smoking campaigns can be good models.
Guiding Rationale Healthcare Advocacy
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Scope of the Presentation
Rationale for Food Matters Program
Environmental and Lifecycle Approach to Food and Health
Scope of Obesity Epidemic
The Western Diet and Chronic Disease
Healthy Diet – First Foods and Beyond
Systemic Drivers of Diet and Food Choice
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Food Matters to Pregnant Women, Children, and Future Generations
Nutrition Matters Good nutrition is an
essential requirement of healthy human development
Vulnerability MattersDeveloping fetus and human are uniquely vulnerable to environmental exposures
Timing MattersHealth consequences of in-utero and early life exposures can manifest across an individual’s lifespan
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Toxic exposuresoxidative stress
Obesity, hypertension,Cardiovascular disease, diabetes
Alzheimer’s, dementia, Parkinson’s
Low birth weight
Early Life Experiences Can Influence Later-life Health and Disease
Aging begins at conception
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Developmental Origins of Adult Disease
“It is suggested that poor nutrition in early life increases susceptibility to the effects of an affluent diet. . .”
Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemicheart disease in England and Wales. Lancet. 1986 May 10;1(8489):1077-81.
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Timing Matters
Painter RC, Roseboom TJ, Bleker OP. Prenatal exposure to the Dutch famine and disease in later life. Reproductive Toxicology. 2005 Sep-Oct;20(3):345-
52.
Early gestation
Three-fold increase in coronary heart disease, more obesity
Mid gestation
Increase in obstructive airways disease
Late gestation
Impaired glucose tolerance
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Environmentally-Driven Western Disease Cluster
Obesity/overweight 2/3 US adults, prevalence X2 in ~25 yrs
Pre/Diabetes 40% US adults. Prevalence DM ~X2 over 20 yrs
Cardiovascular disease Still leading cause of death
Metabolic syndrome Early signs of other cluster diseases; 35% adults, ~55%>60 yrs
Metabolic syndrome in childhood increases the risk of cardiovascular disease in adulthood 15 fold
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Altered Pathways
Mechanisms of Action Underlying Diet-Related Chronic Diseases
Nutritional/ Environmental Factors
Inflammation
Disrupted Insulin Signaling
Oxidative Stress
Chronic Disease
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Mechanisms of Action: Inflammation
Inflammation is a dimension of:
Diabetes Metabolic syndrome Obesity Cardiovascular disease Some neurodegenerative disorders Other chronic illnesses
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Insulin Signaling in Normal Metabolism
Insulin signaling
• ↓ blood sugar• ↓ artery disease• ↓ triglycerides
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Insulin signaling
• ↑ blood sugar• ↑ artery disease• ↑ triglycerides
InflammationOxidative
stress
Disrupted Insulin Signaling = Inflammatory Metabolism
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Some Increasingly Pervasive Nutrients Promote Inflammatory Metabolism
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Trends in U.S. Diet
Soda and fast food linked to ↑ risk of weight gain and diabetes
High fructose corn syrup consumption ↑ over 25% in last 30
years
High-sugar / high-fat foods comprise ~30% of all calories consumed by Americans
Daily calories ↑ over last 20 years (men 168, women 300)
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What’s Changed in the Western Diet?
Years
% o
f calo
ries f
rom
fa
t
mg
/d
ay
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High Glycemic Carbohydrates Increase the risk of chronic disease by breaking down quickly during digestion, rapidly releasing glucose (sugar) into the bloodstream.
Δ P
lasm
a I
nsu
lin
,mg
/dl
Time, mins
INSULINEMIC RESPONSE
Low glycemic foodHigh glycemic food
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Omega-3 Omega-6 Saturated
Food System
Perishable Short shelf life ↑ in pasture-fed animals
Durable Long shelf life Processed foods
↑ in factory- farmed animals
Immune Properties
Anti-inflammatory
Inflammatory&
Anti-inflammatory
Inflammatory
Evolutionary Context
Recent marked decline
Recent marked increase
Properties of Fatty Acids
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Insulin signaling
• ↑ blood sugar• ↑ artery disease• ↑ triglycerides
InflammationOxidative
stress
Disrupted Insulin Signaling = Inflammatory Metabolism
↓Omega-3, (↑Omega-6)
Saturated fat
↓ Antioxidants
High Glycemic Carbohydrates
Fructose
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The Importance of Early Nutrition: In the Womb & Infancy
Developmental programming
Epigenetic: DNA methylation, histone modification,
RNA interference
Establish “set points” of various phenotypic traits;
program immune system, etc.
Influence susceptibility to adult disease; e.g. obesity, metabolic syndrome, diabetes, cancer, neurodegenerative disease, etc.
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Pilot Study: Impact of low glycemic load diet in overweight/obese pregnant women
n=46 Low-GL Diet:
Longer pregnancy duration (delivery <38 weeks 13% vs. 48%)
Greater Infant Head Circumference Lower maternal triglycerides and cholesterol
Dietary interventions may help prevent prematurebirths and other adverse maternal and infantoutcomes.
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Maternal High Glucose and Increased Risk of Diabetes in Children
Prenatal exposure to high levels of maternal blood glucose reduces insulin sensitivity in infants
Gestational diabetes associated with increased risk of Type 2 diabetes in children; not entirely explained by BMI
Rationale for focus on healthy food in pregnant women as a driver of health of future generations
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Breast Feeding Advantages: Infant
Reduced infectious disease pneumonia, gastroenteritis, otitis media, other
Lower risk of type 1 diabetes; type 2 diabetes if mother does not have
diabetes
> 6 mo. decreases the risk of childhood cancer leukemia, Hodgkins, neuroblastoma
Lower risk of inflammatory bowel disease
Improved neurological development and lower asthma risk (inconsistent evidence)
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Breast Feeding Advantages: Maternal
Less postpartum bleeding
Earlier return to pre-pregnancy weight
Improved bone strength; decreased risk of hip fracture later in life
Reduced ovarian and pre-menopausal breast cancer
Birth control
Women who don’t breastfeed have increased risk of type 2 Diabetes
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Increase risks saturated and trans fats high glycemic carbohydrates lack of fruits/vegetables/omega 3s excess omega 6s?
Reduce risks fruits, vegetables, nuts omega 3s low glycemic carbohydrate “Mediterranean-type” diet
Influence of Nutrition on Chronic Disease
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Benefits of Mediterranean-Type Diet on Chronic Disease Risk
Clinical intervention studies
70% ↓ heart attacks, cardiac death & total mortality DeLogeril, 94
60% ↓ cardiac events in CVD patients* Ornish, 98
~50% ↓ metabolic syndrome Esposito, 04
39% ↓ in CRP Esposito, 04
↓ insulin resistance Esposito, 04
↓ weight Esposito, 04*10% low fat, vegetarian diet + exercise, stress reduction
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Benefits of Mediterranean-Type Diet on Chronic Disease Risk
Prospective observation studies
80% ↓ diabetes Martinez-Gonzalez, 08
~31% ↓ all-cause & cardiovascular mortality
22% ↓ cancer mortality** calculated from Sofi, 08
73% ↓ Alzheimer’s mortality Scarmeas, 07
25-30% ↓ Parkinson’s disease Gao, 07
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A Food Systems Approach
Food Environments
Brownell et al., Health Affairs, March 2010 Parker et al.,IOM, 2009
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A Food System Approach
Public Policy
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$25-30 billion per year Twice the amount
needed to provide health and nutrition for everyone in the world. -UNDP 1998
$12 billion per year aimed at marketing to children
A Food System Approach
Advertising
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A Food System Approach
Economic Drivers of Food Choice
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Food deserts Urban and rural communities with
economic and transportation barriers to accessing healthy food
Hunger in America Over 49 million Americans live in
households that are “food insecure” US minimum wage = $7.25/hour
A Food System Approach
Access and Availability
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HEALTH AND ENVIRONMENTAL COSTS
ARE NOT REFLECTED IN THE PRICE OF FOOD OR
ACCOUNTED FOR IN THE FOOD SYSTEM
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Promoting health
Households
Institutions
Communities
Regionally
Nationally, Globally
David Wallinga, Institute for Agriculture and Trade Policy
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Making change
In your practice
Calendars available at www.HealthyFoodinHealthCare.
org
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Increase procurement of healthy food for healthy bodies, farms, communities and environment
Make food a part of the healing process
Lead by example and educate patients, visitors, and the community about healthy, sustainable food
Pool purchasing power to move the marketplace
Making change
In Hospitals
www.HealthyFoodinHealthcare.org
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Making change
In Hospitals
Over 380 Pledge signers
in 26 states
www.HealthyFoodinHealthcare.org
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ProcurementCafeteria &Patient trays
Buying local, organic, fair trade, rBGH-free, antibiotic and hormone-free, grass-fed, cage-free
Reducing meat & sugar sweetened
beverages
↑ Contracting with local and regional
vendors, farmers, distributors and processors
On-site Farmers’ markets & hospital gardens Waste reduction - composting & reusable dishes
Policy Healthy Food in Health Care Pledge Advocating for federal legislation, e.g. Preservation of Antibiotics for Medical Treatment Act
What Health Care Facilities Are Doing
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4 Pilot Hospitals: Reduced meat by 28% in 12
months
Achieved $402,000 savings Used savings to purchase more
sustainably-produced meat
Saved the equivalent of over 1,000 tons/year reductions in greenhouse gas emissions
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Making change
In Hospitals
Balanced Menus Challenge
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Making change
In Communities
Farm to School Farmtoschool.org
Sustainable Table Sustainabletable.org
Community Food Security Coalition Foodsecurity.org
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Making change
Nationally
Sign the Charter atwww.HealthyFoodAction.org
Facebook - A Citizen’s Guide to a Better Food System
Literature: Wallinga D. Contribution of Agricultural Policy to Childhood Obesity. Health Affairs. March 2010
Imhoff. Food Fight: The Citizen’s Guide to a Food and Farm Bill
Webinars: www.HealthyFoodAction.org
The Farm Bill
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Making change
Nationally
Healthy Food ActionMaking Health the Future of Food and Farmingwww.healthyfoodaction.org Safer Chemicals, Healthy FamiliesReform Toxic Substances Control Act (TSCA) to keep toxins out of
foodwww.saferchemicals.org
Preservation of Antibiotics for Medical Treatment Act Sign the Health Care Without Harm Petition www.protectantibiotics.org
Principles of a Healthy, Sustainable Food System
Uniting health professions in a common visionhttp://www.planning.org/nationalcenters/health/food.htm
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Food Matters Clinical Advisory TeamJudy Focareta, RNJoel Forman, MD
Sarah Janssen, MDPreston Maring, MDJoanne Perron, MD
Naomi Stotland, MDDavid Wallinga, MD
Food Matters is made possible with generous support from:
Rose Foundation Stonyfield Organics Profits for the Planet Program The Cedar
Tree FoundationThe Orchard Foundation W.K. Kellogg Foundation
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