Healthy eating for middle-years

Professor Tom Sanders

Nutritional Sciences Division

Major causes of premature death in middle-aged subjects• Smoking related illness

• Alcoholism

• Diet related disease – cardiovascular disease and type 2 diabetes

• Cancer

2

Storing fat in the wrong place

Metabolic syndrome

Coronary Heart DiseaseCoronary Heart Disease

Type 2Type 2DiabetesDiabetes

HighHighLDL-CLDL-C

MetabolicMetabolicSyndromeSyndrome

Relative Risk of Diabeteswith increasing BMI

05

1015202530354045

<23 23-24.9 25-29.9 30-34.9 >35

What is driving obesity

Decreased physical activity

Increased energy intake among the susceptible

Increased access to high energy density foods especially outside the home

Effect of fat additions on energy density

0 50 100 150 200 250 300 350

kcal/100g

Boiled potato

French fries

Cod baked

Cod fried in batter

Boiled rice

Fried rice

Chicken

Chicken fried

Chapatis made without fat

Chapati made with fat

SCRATCH COOKING

COMPONENT COOKING

READY MEALS

TAKE-AWAYSSNACKING

‘ON THE HOOF’

DELIVERY QSR RESTAURANT

High skill base, time consuming, “food”

focused

Convenient social

e.g. primary products, traditional grocery

e.g. prepared vegetables,

prepared meat/fish,

sauces, pizza

e.g. Sandwiches,

Sushi

© WorldpanelTM division of TNS 2003

Slow Food Fast Food

Physical inactivityPhysical activity

What we know about obesity management• Calorie intake must be decreased

(no clear difference between fat and carbohydrate calories)

• Portion control is crucial

• Avoid temptation – “Willpower lasts 2 weeks and is soluble in alcohol”

Fat patterning associated with metabolic syndrome

Obesity and metabolic syndrome• Obesity contributes to causing

metabolic syndrome

• Physical activity is protective

• A diet high in rapidly absorbed carbohydrate (both starch and sugar) makes metabolic syndrome worse

15

Healthy artery

Atherosclerosis (chronic)

Thrombosis

(acute)

16

Health Survey 2003 England & Wales

0

10

20

30

40

50

60

70

80

16-24 25-34 35-44 45-54 55-64 65-74 75+Age group

% w

ith h

yper

ten

sio

n

All

Treated

Untreated

Dietary factors contributing to raised blood pressure• Overweight

• Excess alcohol intake

• Low intake of fruit and vegetables

• High salt intakes

19

Dietary factors influence blood cholesterol• Overweight

• High intake of saturated fat

• Unfiltered or boiled coffee (usually not significant unless large amounts consumed

• Cholesterol in foods such as eggs (small effect)

21

24

Iso et al. Circulation 2006;113:195-202.

Intake of long chain n-3 fatty acids in 41,578 Japanese men and women and risk of CHD over 10 years

25

3.58 4.76 5.63 6.870.0

0.5

1.0

Albert et al. N Eng J Med 2002; 346:1113-8

% long-chain n-3 fatty acids in blood lipids

Rel

ativ

e ri

sk

Risk of sudden death adjusted for risk factors in men enrolled in the Physicians Health Study

GISSI_HFLancet 2008 Editorial“A simple and safe treatment with n-3 PUFA can provide a small beneficial advantage in terms ofmortality and admission to hospital for cardiovascular reasons in patients with heart failure in a context of usualcare.

George Davey SmithLancet Jan 2009“A reasonable interpretation of the GISSI-HF trial would be that the modest estimated effect of fish oil requires replication.”

27

UK government recommendation on intakes in relation to reducing risk of cardiovascular disease

Aim to consume two portions of fish per week one of which should be oily

Providing ~3g long-chain n-3 PUFA/week or 0.45g/d

Effect on risk of CHD events of replacing 5% energy saturated fatty acids from pooled analysis of 11 cohort studies

Jakobsen M et al. Am J Clin Nutr 2009;89:1-8.

Dietary advice to prevent heart disease

• Avoid overweight/obesity

• Replace sources of saturated fat with unsaturated fat (i.e. liquid oils for hard fats)

• Eat more fish especially oil fish and less fatty meat

• Cut down on salt

• Avoid excessive consumption of sugar sweetened drinks and alcohol

29

21st November 2006: FDF GDA Briefing

21st November 2006: FDF GDA Briefing

Cheddar

Reduced fat cheddar

A

B